Provider Demographics
NPI:1184847840
Name:YAKOSCHUESZLER, MARY ELLEN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELLEN
Last Name:YAKOSCHUESZLER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:YAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:995 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1322
Mailing Address - Country:US
Mailing Address - Phone:330-722-0198
Mailing Address - Fax:216-842-8502
Practice Address - Street 1:7377 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-6000
Practice Address - Country:US
Practice Address - Phone:216-990-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist