Healthcare Provider Details

I. General information

NPI: 1477403681
Provider Name (Legal Business Name): ANGELA M GUNDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SW 7TH AVENUE
GRAND RAPIDS MN
55744
US

IV. Provider business mailing address

44665 COUNTY ROAD 128
DEER RIVER MN
56636-2326
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-5870
  • Fax:
Mailing address:
  • Phone: 218-892-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number102372
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: