Provider Demographics
NPI:1447287214
Name:HUNTSINGER, AUDREY G (COTA)
Entity type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:G
Last Name:HUNTSINGER
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 1:4206 RETAMA CIR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2765
Mailing Address - Country:US
Mailing Address - Phone:361-582-0611
Mailing Address - Fax:361-582-0555
Practice Address - Street 1:4206 RETAMA CIR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2765
Practice Address - Country:US
Practice Address - Phone:361-582-0611
Practice Address - Fax:361-582-0555
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164704201Medicaid
TX454843Medicare Oscar/Certification