Provider Demographics
NPI:1245568203
Name:SMITH, JULINA MICHELLE (OT/L)
Entity Type:Individual
Prefix:
First Name:JULINA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:JULINA
Other - Middle Name:MICHELLE
Other - Last Name:LAMBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT/L
Mailing Address - Street 1:437 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:765-376-2726
Mailing Address - Fax:765-448-3898
Practice Address - Street 1:1531 13TH ST
Practice Address - Street 2:STE G90
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:765-448-1758
Practice Address - Fax:765-448-3898
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003856A225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist