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General NPI Number Information
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NPI Number | 1568489656
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE YENULEVICH MS/OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2413 PROFESSIONAL DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2254
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Country | US
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Telephone | 252-443-0808
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Fax | 252-451-9032
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Provider Business Mailing Address
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Address Line | 3153 OAKLYN SPRINGS DR
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City | RALEIGH
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State | NC
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Zip | 27606-8311
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Country | US
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Telephone | 919-779-7944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3001
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License Number State | NC
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