Provider Demographics
NPI:1386664878
Name:DICER, JULIE R (MS OTRL)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:DICER
Suffix:
Gender:F
Credentials:MS OTRL
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 6588
Mailing Address - Street 2:ST MARYS HOME HEALTH CARE
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-9828
Mailing Address - Country:US
Mailing Address - Phone:706-389-2273
Mailing Address - Fax:706-208-8883
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2179
Practice Address - Country:US
Practice Address - Phone:706-389-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOO3204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00897179AMedicaid