Provider Demographics
NPI:1710749510
Name:KARUMANCHI, DIVYA RAMA
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:RAMA
Last Name:KARUMANCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:YALAMURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7139 CREEKS XING
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3504
Mailing Address - Country:US
Mailing Address - Phone:323-633-2276
Mailing Address - Fax:
Practice Address - Street 1:7139 CREEKS XING
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3504
Practice Address - Country:US
Practice Address - Phone:323-633-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist