Provider Demographics
NPI:1235125279
Name:HARMON, JULIE A (OTRL)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HARMON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JEFFRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:931 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5070
Practice Address - Country:US
Practice Address - Phone:563-243-7814
Practice Address - Fax:563-243-2441
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00532225X00000X
IL056003312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18344Medicare PIN
IL555650Medicare PIN