Provider Demographics
NPI:1124278635
Name:FUNG, JEANNE MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:FUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:CATTAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14817 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2429
Mailing Address - Country:US
Mailing Address - Phone:515-229-0629
Mailing Address - Fax:
Practice Address - Street 1:14817 DELLWOOD DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2429
Practice Address - Country:US
Practice Address - Phone:515-229-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00612225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist