Provider Demographics
NPI:1073680732
Name:KAGAN, JULE G (MOT-OTRL)
Entity Type:Individual
Prefix:
First Name:JULE
Middle Name:G
Last Name:KAGAN
Suffix:
Gender:F
Credentials:MOT-OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CRESSINGTON BND NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6090
Mailing Address - Country:US
Mailing Address - Phone:770-479-1950
Mailing Address - Fax:
Practice Address - Street 1:2877 CRESSINGTON BND NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6090
Practice Address - Country:US
Practice Address - Phone:770-479-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002591225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000903724BMedicaid