Provider Demographics
NPI:1013039056
Name:MEYERS, JULIE D (OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:MEYERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3001
Mailing Address - Country:US
Mailing Address - Phone:708-228-0549
Mailing Address - Fax:708-482-4525
Practice Address - Street 1:547 9TH AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-3001
Practice Address - Country:US
Practice Address - Phone:708-228-0549
Practice Address - Fax:708-482-4525
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILJM31210399POtherILLINOIS EI PROVIDER