Provider Demographics
NPI:1083015051
Name:WILLIFORD, JULIE (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTR/L
Mailing Address - Street 1:10450 SHAKER DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1143
Mailing Address - Country:US
Mailing Address - Phone:410-997-0037
Mailing Address - Fax:
Practice Address - Street 1:10450 SHAKER DR
Practice Address - Street 2:SUITE 113
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1143
Practice Address - Country:US
Practice Address - Phone:410-997-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07502225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07502OtherOCCUPATIONAL THERAPY LICENSE