Provider Demographics
NPI:1265245377
Name:MATUNDAN, MARCUS CHRISTIAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:CHRISTIAN
Last Name:MATUNDAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 W WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2484
Mailing Address - Country:US
Mailing Address - Phone:630-488-9476
Mailing Address - Fax:
Practice Address - Street 1:112 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1200
Practice Address - Country:US
Practice Address - Phone:331-218-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.016424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist