Basic Information
| Provider Information | |||||||||
| NPI: | 1740588078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MLUNGWANA | ||||||||
| FirstName: | DUMISANI | ||||||||
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| Credential: | O.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 JADE DR | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473969263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657595807 | ||||||||
| FaxNumber: | 7653810433 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 CHATEAU DR | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473031900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657479044 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31002328A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.