Provider Demographics
NPI:1477634822
Name:MCKAGAN, JULIA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:MCKAGAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1504
Mailing Address - Country:US
Mailing Address - Phone:262-363-3629
Mailing Address - Fax:
Practice Address - Street 1:727 CTY. RD. NNE
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1011
Practice Address - Country:US
Practice Address - Phone:262-363-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist