Individual
JENNELL MUNDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
11840 S LA CIENEGA BLVD, HAWTHORNE, CA 90250-3459
(307) 259-6103
Mailing address
11840 S LA CIENEGA BLVD, HAWTHORNE, CA 90250-3459
(307) 259-6103
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11593
CA
225X00000X
Occupational Therapist
12533
MA
Other
Enumeration date
02/07/2011
Last updated
05/08/2018
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