Provider Demographics
NPI:1770758658
Name:MUNDIGLER, LAURA ANNE (OTR)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANNE
Last Name:MUNDIGLER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 FREELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1658
Mailing Address - Country:US
Mailing Address - Phone:414-210-0088
Mailing Address - Fax:414-509-1630
Practice Address - Street 1:7711 FREELAND CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1658
Practice Address - Country:US
Practice Address - Phone:414-210-0088
Practice Address - Fax:414-509-1630
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2799-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist