Provider Demographics
NPI:1548702087
Name:DEMENIUK, DARLENE (OT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:DEMENIUK
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 1:6050 SHADOW PINES CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7188
Mailing Address - Country:US
Mailing Address - Phone:517-376-6430
Mailing Address - Fax:810-844-0837
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR
Practice Address - Street 2:STE 170
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7004
Practice Address - Country:US
Practice Address - Phone:810-299-8550
Practice Address - Fax:810-844-0837
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005659225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist