Provider Demographics
NPI:1104470103
Name:LUNDGREN, ANNA KATHERINE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHERINE
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S 2500 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3246
Mailing Address - Country:US
Mailing Address - Phone:406-250-8971
Mailing Address - Fax:
Practice Address - Street 1:2016 S 2500 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3246
Practice Address - Country:US
Practice Address - Phone:406-250-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10863478-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist