Provider Demographics
NPI:1235520578
Name:HAVERDINK, JULIE (LOT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HAVERDINK
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50805
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0805
Mailing Address - Country:US
Mailing Address - Phone:940-380-0311
Mailing Address - Fax:940-380-9605
Practice Address - Street 1:5201 INDIANA AVE
Practice Address - Street 2:#200 CENTRAL
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4200
Practice Address - Country:US
Practice Address - Phone:806-791-2100
Practice Address - Fax:806-791-2105
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106995225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist