Provider Demographics
NPI:1942729587
Name:YAKUTCHIK, DENISE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:YAKUTCHIK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 BRIARHILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2920
Mailing Address - Country:US
Mailing Address - Phone:315-243-9259
Mailing Address - Fax:
Practice Address - Street 1:1194 NAAMANS CREEK RD
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-1615
Practice Address - Country:US
Practice Address - Phone:610-558-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist