Provider Demographics
NPI:1083015929
Name:HASSELL, JULIA (ATC, OTC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:HASSELL
Suffix:
Gender:F
Credentials:ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6227
Mailing Address - Country:US
Mailing Address - Phone:734-673-6578
Mailing Address - Fax:
Practice Address - Street 1:1109 W MYRTLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6970
Practice Address - Country:US
Practice Address - Phone:208-383-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer