MEDICARE: SIERRA DAWN GUNDERSON

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	224Z00000X	Occupational Therapy Assistant	700227	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336860865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA DAWN GUNDERSON

Provider Business Mailing Address
First Line	:	W16092 COUNTY RD S
Second Line	:
City	:	STANLEY
State	:	WI
Zip	:	54768-9302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 116TH ST
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-5569
Country	:	US
Telephone Number	:	715-239-2075
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	04/17/2025

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