Provider Demographics
NPI:1588230973
Name:PUNG, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1235
Mailing Address - Country:US
Mailing Address - Phone:330-858-7043
Mailing Address - Fax:
Practice Address - Street 1:619 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1203
Practice Address - Country:US
Practice Address - Phone:234-274-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist