Provider Demographics
NPI:1831366228
Name:JUNG, KIM M (COTA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:JUNG
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 1:8534 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1934
Mailing Address - Country:US
Mailing Address - Phone:414-353-2300
Mailing Address - Fax:414-353-2727
Practice Address - Street 1:8534 W MILL RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1934
Practice Address - Country:US
Practice Address - Phone:414-353-2300
Practice Address - Fax:414-353-2727
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI939-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant