Healthcare Provider Details

I. General information

NPI: 1427319383
Provider Name (Legal Business Name): JOAN MARIE MUNDY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 INDIANAPOLIS RD
GREENCASTLE IN
46135-1458
US

IV. Provider business mailing address

1140 INDIANAPOLIS RD
GREENCASTLE IN
46135-1458
US

V. Phone/Fax

Practice location:
  • Phone: 765-848-1421
  • Fax: 765-301-4351
Mailing address:
  • Phone: 765-848-1421
  • Fax: 765-301-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31001178A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: