Provider Demographics
NPI:1073041901
Name:REPLOGLE, JULIE (MS OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:REPLOGLE
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E COOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3656
Mailing Address - Country:US
Mailing Address - Phone:260-487-4226
Mailing Address - Fax:260-490-5433
Practice Address - Street 1:409 E COOK RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3656
Practice Address - Country:US
Practice Address - Phone:260-487-4226
Practice Address - Fax:260-490-5433
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006208A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31006208AOtherOCCUPATIONAL THERAPY COMMITTEE