Provider Demographics
NPI:1235417908
Name:IYOHA, RUFUS ONUS (OTR)
Entity type:Individual
Prefix:
First Name:RUFUS
Middle Name:ONUS
Last Name:IYOHA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13716 CORTES DE PALLAS DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0829
Mailing Address - Country:US
Mailing Address - Phone:469-544-3993
Mailing Address - Fax:
Practice Address - Street 1:1864 STONEBROOK DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6421
Practice Address - Country:US
Practice Address - Phone:269-978-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114315225X00000X, 225XG0600X
MI5201008002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist