Provider Demographics
NPI:1114570413
Name:YARMOLUK, DAVID GREGORY (OTD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GREGORY
Last Name:YARMOLUK
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 DUNDEE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9565
Mailing Address - Country:US
Mailing Address - Phone:517-902-1950
Mailing Address - Fax:
Practice Address - Street 1:218 DUNDEE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9565
Practice Address - Country:US
Practice Address - Phone:517-902-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist