Provider Demographics
NPI:1316383003
Name:MATHIS, JULIE BARINEAU (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BARINEAU
Last Name:MATHIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-4522
Mailing Address - Country:US
Mailing Address - Phone:850-868-0623
Mailing Address - Fax:
Practice Address - Street 1:296 CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-4522
Practice Address - Country:US
Practice Address - Phone:850-868-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12926302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308933OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
FLOTA12926OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE