Provider Demographics
NPI:1033497540
Name:LEWIS, JULIETTE A (OTA)
Entity Type:Individual
Prefix:MISS
First Name:JULIETTE
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MISS
Other - First Name:JULIETTE
Other - Middle Name:A
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTA
Mailing Address - Street 1:42 PARK PL APT 3A
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4246
Mailing Address - Country:US
Mailing Address - Phone:914-310-7922
Mailing Address - Fax:
Practice Address - Street 1:42 PARK PL APT 3A
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4246
Practice Address - Country:US
Practice Address - Phone:914-310-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64007814224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant