Provider Demographics
NPI:1992797286
Name:GUNDERMAN, JENNIFER L (OT-CHT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GUNDERMAN
Suffix:
Gender:F
Credentials:OT-CHT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:RAAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2132 GAUSE BLVD E STE 6
Mailing Address - Street 2:SLIDELL, LA
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4243
Mailing Address - Country:US
Mailing Address - Phone:985-646-2531
Mailing Address - Fax:
Practice Address - Street 1:2132 GAUSE BLVD E STE 6
Practice Address - Street 2:SLIDELL, LA
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4243
Practice Address - Country:US
Practice Address - Phone:985-646-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200798225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q32032Medicare UPIN
NYQT8361Medicare PIN