Healthcare Provider Details

I. General information

NPI: 1831322171
Provider Name (Legal Business Name): DENISE M. KURELKO MA CCC-SLP, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
YOUNGSTOWN OH
44555-0001
US

IV. Provider business mailing address

406 ATWOOD CT
DOWNERS GROVE IL
60516-3054
US

V. Phone/Fax

Practice location:
  • Phone: 215-630-0123
  • Fax:
Mailing address:
  • Phone: 215-630-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007416
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 8310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: