Provider Demographics
NPI:1285757682
Name:SCHUNK, ANNETTE CYNTHIA (COTA)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:CYNTHIA
Last Name:SCHUNK
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 1:5 FERRO DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9313
Mailing Address - Country:US
Mailing Address - Phone:856-218-4881
Mailing Address - Fax:856-218-4881
Practice Address - Street 1:550 JESSUP RD
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1921
Practice Address - Country:US
Practice Address - Phone:856-848-9551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09062500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant