Provider Demographics
NPI:1437331113
Name:YUCHA, MICHAEL P (OTRL)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:YUCHA
Suffix:
Gender:M
Credentials:OTRL
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 419
Mailing Address - Street 2:OCCUPATIONAL THERAPY PROGRAMS
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-0419
Mailing Address - Country:US
Mailing Address - Phone:610-356-7355
Mailing Address - Fax:610-355-7649
Practice Address - Street 1:100 MEDIA LINE ROAD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4602
Practice Address - Country:US
Practice Address - Phone:610-356-7355
Practice Address - Fax:610-355-7649
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006724L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019247770006Medicaid