Andrew John Mundt-Fettkether

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

413330 Issued in OR

Practice address

5330 NE Prescott St
Portland, OR 97218-2158

Phone

(503) 288-6585

NPI assigned

Dec 5, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575504000000",
    "number": "1114564481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5330 NE PRESCOTT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972182158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 NE PRESCOTT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972182158",
            "telephone_number": "503-288-6585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNDT-FETTKETHER",
        "first_name": "ANDREW",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-05",
        "last_updated": "2019-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "413330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajmundt-fettkether@infinityrehab.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5330 NE Prescott St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972182158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Myrna Y. Munar, PHARM.D.
• Chad Muncrief, ND
• Tony D Munden, CADC2
• Susan Lynn Mundigel, CADCI
• Chandra Mundon, PSY.D.
• Lisa Ann Mungenast, CRM, PSS, THW
• Darby Joanne Munger
• Ute I Munger
• Elizabeth Elvi Mungovan
• Caterin Munguia

• Occupational Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.