Jennell Mundorf, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

11593 Issued in CA

Practice address

11840 S la Cienega Blvd
Hawthorne, CA 90250-3459

Phone

(307) 259-6103

NPI assigned

Feb 7, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525737600000",
    "number": "1659677722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11840 S LA CIENEGA BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503459",
            "telephone_number": "307-259-6103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11840 S LA CIENEGA BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503459",
            "telephone_number": "307-259-6103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1055 Pine St Apt 326",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "37203",
            "country_code": "US",
            "telephone_number": "307-259-6103",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 Bear Hill Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Waltham",
            "state": "MA",
            "postal_code": "024511004",
            "country_code": "US",
            "telephone_number": "781-790-8479",
            "fax_number": "781-281-9181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUNDORF",
        "first_name": "JENNELL",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-07",
        "last_updated": "2018-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MA",
            "license": "12533",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "11593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; 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.