Provider Demographics
NPI:1275915381
Name:STUART, JULIE ALICIA (OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ALICIA
Last Name:STUART
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:PO BOX 45776
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5776
Mailing Address - Country:US
Mailing Address - Phone:631-475-1241
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD BLDG 5-6
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-2858
Practice Address - Fax:631-475-2886
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2021-07-28
Deactivation Date:2019-12-30
Deactivation Code:
Reactivation Date:2021-02-12
Provider Licenses
StateLicense IDTaxonomies
NY023035-1225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist