Provider Demographics
NPI:1376615484
Name:SMITH, JULIANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:KROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12819 133RD PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3303
Mailing Address - Country:US
Mailing Address - Phone:425-367-8822
Mailing Address - Fax:
Practice Address - Street 1:12819 133RD PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3303
Practice Address - Country:US
Practice Address - Phone:425-367-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003680225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8359622Medicaid