Provider Demographics
NPI:1972826337
Name:FULTON, YVONNE R (OT)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:R
Last Name:FULTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7971 MOORSBRIDGE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4075
Mailing Address - Country:US
Mailing Address - Phone:269-321-0929
Mailing Address - Fax:
Practice Address - Street 1:7971 MOORSBRIDGE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4075
Practice Address - Country:US
Practice Address - Phone:269-321-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist