Provider Demographics
NPI:1780926329
Name:MEDUNA, ERIK MICHAEL
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:MICHAEL
Last Name:MEDUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ERIK
Other - Middle Name:MICHAEL
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2920 HANNAH AVE APT G169
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1553
Mailing Address - Country:US
Mailing Address - Phone:509-475-2649
Mailing Address - Fax:
Practice Address - Street 1:2920 HANNAH AVE APT G169
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1553
Practice Address - Country:US
Practice Address - Phone:509-475-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012760225X00000X
WAOT60279328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist