Provider Demographics
NPI:1043346620
Name:NODSLE, JULIE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:NODSLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ROOSEVELT AVE
Mailing Address - Street 2:# 301
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3744
Mailing Address - Country:US
Mailing Address - Phone:218-844-5555
Mailing Address - Fax:218-844-6057
Practice Address - Street 1:803 ROOSEVELT AVE
Practice Address - Street 2:# 301
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3744
Practice Address - Country:US
Practice Address - Phone:218-844-5555
Practice Address - Fax:218-844-6057
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN088S4N0OtherBLUE CROSS BLUE SHIELD
MN29111OtherNORIDIAN
MN073878600Medicaid
MN29111OtherNORIDIAN