Provider Demographics
NPI:1316389125
Name:SUNG, JENNY K (OTR)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:K
Last Name:SUNG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3230 LAKE WORTH RD STE C
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3694
Mailing Address - Country:US
Mailing Address - Phone:561-968-7788
Mailing Address - Fax:561-968-9969
Practice Address - Street 1:3230 LAKE WORTH RD STE C
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-968-7788
Practice Address - Fax:561-968-9969
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHL927ZMedicare UPIN