Healthcare Provider Details

I. General information

NPI: 1063383982
Provider Name (Legal Business Name): HANNAH GUNDEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 WYOMING BLVD NE STE 108
ALBUQUERQUE NM
87109-3193
US

IV. Provider business mailing address

5345 WYOMING BLVD NE STE 108
ALBUQUERQUE NM
87109-3193
US

V. Phone/Fax

Practice location:
  • Phone: 505-537-9906
  • Fax: 505-317-2532
Mailing address:
  • Phone: 505-537-9906
  • Fax: 505-317-2532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-2024-0006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: