Provider Demographics
NPI:1134263791
Name:GUENDELSBERGER, MANDY
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:GUENDELSBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-0662
Mailing Address - Country:US
Mailing Address - Phone:520-991-6855
Mailing Address - Fax:520-325-8259
Practice Address - Street 1:1601 N TUCSON BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3425
Practice Address - Country:US
Practice Address - Phone:520-325-3540
Practice Address - Fax:520-325-8259
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist