MEDICARE: MISS OLUMAYOWA ENOMA-YUSUF , OTD OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	OTH007661	AZ

General Provider Information

NPI Number	:	1942653761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS OLUMAYOWA ENOMA-YUSUF , OTD OTR/L

Provider Business Mailing Address
First Line	:	12164 E DOMNITCH DR
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-6873
Country	:	US
Telephone Number	:	520-757-3035
Fax Number	:

Provider Business Practice Location Address
First Line	:	12164 E DOMNITCH DR
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-6873
Country	:	US
Telephone Number	:	520-757-3035
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2016
Last Update Date	:	01/07/2026

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