MEDICARE: LAURA GUNDERSON MOT, OTR/L, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	104106	MN

General Provider Information

NPI Number	:	1134511785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GUNDERSON MOT, OTR/L, CLT

Provider Business Mailing Address
First Line	:	4442 MANOR DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-7413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4442 MANOR DR NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-7413
Country	:	US
Telephone Number	:	701-739-3495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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