Provider Demographics
NPI:1598225211
Name:ULLERY, GEORGE RICHARD III (OTRL)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RICHARD
Last Name:ULLERY
Suffix:III
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 1:2311 E GINTER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8936
Mailing Address - Country:US
Mailing Address - Phone:989-600-1537
Mailing Address - Fax:
Practice Address - Street 1:1620 S MISSION ST STE O
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4466
Practice Address - Country:US
Practice Address - Phone:989-282-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010472225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist