Individual
ANDREW JOHN MUNDT-FETTKETHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5330 NE PRESCOTT ST, PORTLAND, OR 97218-2158
(503) 288-6585
Mailing address
5330 NE PRESCOTT ST, PORTLAND, OR 97218-2158
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
413330
OR
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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