Provider Demographics
NPI:1255315024
Name:HETHERINGTON, JULIA B (MHS OTR CHT)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:B
Last Name:HETHERINGTON
Suffix:
Gender:F
Credentials:MHS OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PROFESSIONAL VILLAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907
Mailing Address - Country:US
Mailing Address - Phone:843-521-9673
Mailing Address - Fax:843-986-9369
Practice Address - Street 1:18 PROFESSIONAL VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907
Practice Address - Country:US
Practice Address - Phone:843-521-9673
Practice Address - Fax:843-986-9369
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1092225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q31935Medicare UPIN
SCQ319357554Medicare ID - Type Unspecified