Provider Demographics
NPI:1083127112
Name:GUPTON, JULIA PAIGE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:PAIGE
Last Name:GUPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4905
Mailing Address - Country:US
Mailing Address - Phone:704-351-7680
Mailing Address - Fax:
Practice Address - Street 1:237 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4471
Practice Address - Country:US
Practice Address - Phone:910-754-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant