Provider Demographics
NPI:1700051976
Name:JENKINS, NORMARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:NORMARIE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 FM 2086
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-3612
Mailing Address - Country:US
Mailing Address - Phone:254-984-0056
Mailing Address - Fax:254-984-0036
Practice Address - Street 1:2104 N KARNES AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-1055
Practice Address - Country:US
Practice Address - Phone:254-697-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208308224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant