Provider Demographics
NPI:1003226515
Name:VOLLNOGEL, JUANITA REBECCA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:REBECCA
Last Name:VOLLNOGEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-8683
Mailing Address - Country:US
Mailing Address - Phone:620-669-3571
Mailing Address - Fax:
Practice Address - Street 1:108 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:KS
Practice Address - Zip Code:67546-8016
Practice Address - Country:US
Practice Address - Phone:620-712-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03815225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology