Provider Demographics
NPI:1417668872
Name:MABE, JULIA ALYCE (OTDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ALYCE
Last Name:MABE
Suffix:
Gender:F
Credentials:OTDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151-B RUTLEDGE AVENUE
Mailing Address - Street 2:MSC 962
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-9620
Mailing Address - Country:US
Mailing Address - Phone:843-792-0701
Mailing Address - Fax:
Practice Address - Street 1:151-B RUTLEDGE AVENUE
Practice Address - Street 2:MSC 962
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-9620
Practice Address - Country:US
Practice Address - Phone:843-792-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program