Provider Demographics
NPI:1285630103
Name:CARPENTER, JULIE M (OT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 N MILDRED RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2212
Mailing Address - Country:US
Mailing Address - Phone:970-564-0311
Mailing Address - Fax:970-564-0313
Practice Address - Street 1:1280 N MILDRED RD
Practice Address - Street 2:STE 2
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2212
Practice Address - Country:US
Practice Address - Phone:970-564-0311
Practice Address - Fax:970-564-0313
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38274329Medicaid
CO38274329Medicaid