Individual
SHANA COYETTE BUNDRAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 HUNTINGDON PIKE, MEADOWBROOK, PA 19046-8098
(215) 938-4000
Mailing address
500 E UPSAL ST APT 204, PHILADELPHIA, PA 19119-3931
(215) 429-9994
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP008915
PA
Other
Enumeration date
06/11/2018
Last updated
06/11/2018
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