Provider Demographics
NPI:1942878459
Name:KIM, TAMMY SUNJUNG (COTA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUNJUNG
Last Name:KIM
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 1:847 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MAGGIE VALLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28751-8863
Mailing Address - Country:US
Mailing Address - Phone:951-541-4388
Mailing Address - Fax:
Practice Address - Street 1:1349 CRABTREE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-7315
Practice Address - Country:US
Practice Address - Phone:828-454-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14170224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant