Provider Demographics
NPI:1487367488
Name:KUMANCHIK, JULIA L (COTA/L)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:KUMANCHIK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:L
Other - Last Name:PUMROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4114
Mailing Address - Country:US
Mailing Address - Phone:937-623-9247
Mailing Address - Fax:
Practice Address - Street 1:829 YELLOW SPRINGS FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-7675
Practice Address - Country:US
Practice Address - Phone:937-878-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06335224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant