Provider Demographics
NPI:1427190313
Name:SMALL, JULIE MERINDA (OTRL)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MERINDA
Last Name:SMALL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRAY RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9237
Mailing Address - Country:US
Mailing Address - Phone:252-675-7997
Mailing Address - Fax:
Practice Address - Street 1:4218 ARENDELL ST
Practice Address - Street 2:SUITE M
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2866
Practice Address - Country:US
Practice Address - Phone:252-808-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5369225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD3062Medicare UPIN
NCD3062Medicare UPIN