Provider Demographics
NPI:1033270061
Name:VERMILYA, DENISE WALZ (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:WALZ
Last Name:VERMILYA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670207
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0121
Mailing Address - Country:US
Mailing Address - Phone:770-517-2480
Mailing Address - Fax:770-592-9431
Practice Address - Street 1:2465 CANOPY GLN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1541
Practice Address - Country:US
Practice Address - Phone:770-517-2480
Practice Address - Fax:770-592-9431
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0413225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0413OtherOCCUPATIONAL THERPAY LICE
GA643429152AMedicaid