Provider Demographics
NPI:1053569632
Name:YARNELL, WANDA KAY (MAOTR/L)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:KAY
Last Name:YARNELL
Suffix:
Gender:F
Credentials:MAOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MARKET AVE N
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2603
Mailing Address - Country:US
Mailing Address - Phone:330-452-3458
Mailing Address - Fax:330-452-3435
Practice Address - Street 1:1223 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2603
Practice Address - Country:US
Practice Address - Phone:330-452-3458
Practice Address - Fax:330-452-3435
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 007002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist