Provider Demographics
NPI:1538287933
Name:BOSLEY, JULIE C (OCCUP THERAPIST)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:BOSLEY
Suffix:
Gender:F
Credentials:OCCUP THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DEER CREEK
Mailing Address - State:IL
Mailing Address - Zip Code:61733-9358
Mailing Address - Country:US
Mailing Address - Phone:309-264-4573
Mailing Address - Fax:
Practice Address - Street 1:901 ILLINI DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-1840
Practice Address - Country:US
Practice Address - Phone:309-241-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-005771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist