Provider Demographics
NPI:1225425812
Name:YCOY, JULIE ANNE MAYONTE (OTR)
Entity Type:Individual
Prefix:
First Name:JULIE ANNE
Middle Name:MAYONTE
Last Name:YCOY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10133 SHERRILL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3347
Mailing Address - Country:US
Mailing Address - Phone:754-802-5003
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:10133 SHERRILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3347
Practice Address - Country:US
Practice Address - Phone:754-802-5003
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3309225X00000X
SC5050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist