Provider Demographics
NPI:1386133767
Name:GUNDERSEN, TAMARA LYNN
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:GUNDERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 KLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9700
Mailing Address - Country:US
Mailing Address - Phone:484-300-7412
Mailing Address - Fax:
Practice Address - Street 1:404 KLEMAN RD
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9700
Practice Address - Country:US
Practice Address - Phone:484-300-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist