Healthcare Provider Details

I. General information

NPI: 1235417908
Provider Name (Legal Business Name): RUFUS ONUS IYOHA OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 STONEBROOK DR NE
GRAND RAPIDS MI
49505-6421
US

IV. Provider business mailing address

13716 CORTES DE PALLAS DR
LITTLE ELM TX
75068-0829
US

V. Phone/Fax

Practice location:
  • Phone: 269-978-3062
  • Fax:
Mailing address:
  • Phone: 469-544-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number114315
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201008002
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number114315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: