Provider Demographics
NPI:1679301220
Name:NUNEZ, JENNIFER I (COTA/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:I
Last Name:NUNEZ
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 1:112 SE SUNGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6436
Mailing Address - Country:US
Mailing Address - Phone:580-483-1467
Mailing Address - Fax:
Practice Address - Street 1:1401 SW PARKRIDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9200
Practice Address - Country:US
Practice Address - Phone:580-730-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1167224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant