Provider Demographics
NPI:1922878206
Name:TUNGET, KATRINA JEWEL (COTA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:JEWEL
Last Name:TUNGET
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 1:1204 HARRISON SHIPMAN RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-4938
Mailing Address - Country:US
Mailing Address - Phone:205-754-4570
Mailing Address - Fax:
Practice Address - Street 1:1204 HARRISON SHIPMAN RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-4938
Practice Address - Country:US
Practice Address - Phone:205-754-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5241224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant