Active NPI
Marcus Christian Matundan, OTR/L
- Occupational Therapist
- Carol Stream, IL
National Provider Identifier
1265245377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056.016424
- Practice address
- 112 Windsor Park Dr
Carol Stream, IL 60188-1200 - Phone
- (331) 218-3637
- NPI assigned
- Jan 31, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.016424 | IL | Primary |
Addresses
Primary practice location
112 Windsor Park Dr
Carol Stream, IL 60188-1200
Mailing address
168 W Wrightwood Ave
Glendale Heights, IL 60139-2484
Phone (630) 488-9476
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.016424 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1265245377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "168 W WRIGHTWOOD AVE",
"city": "GLENDALE HEIGHTS",
"state": "IL",
"postal_code": "601392484",
"telephone_number": "630-488-9476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 WINDSOR PARK DR",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "601881200",
"telephone_number": "331-218-3637"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATUNDAN",
"first_name": "MARCUS",
"middle_name": "CHRISTIAN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-31",
"last_updated": "2025-01-31",
"certification_date": "2025-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056.016424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carol Stream, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.