Provider Demographics
NPI:1306217104
Name:BATES, JULIA ANN
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:MAGNUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7414 E GRAND AVE
Mailing Address - Street 2:APT 434
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-5800
Mailing Address - Country:US
Mailing Address - Phone:651-808-8738
Mailing Address - Fax:
Practice Address - Street 1:1350 E LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4106
Practice Address - Country:US
Practice Address - Phone:972-220-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201804224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant