Provider Demographics
NPI:1568489656
Name:YENULEVICH, KATHLEEN MARIE (MS/OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:YENULEVICH
Suffix:
Gender:F
Credentials:MS/OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 OAKLYN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8311
Mailing Address - Country:US
Mailing Address - Phone:919-779-7944
Mailing Address - Fax:
Practice Address - Street 1:2413 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2254
Practice Address - Country:US
Practice Address - Phone:252-443-0808
Practice Address - Fax:252-451-9032
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist