Provider Demographics
NPI:1558690131
Name:HEWITT, JULIE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HEWITT
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:GILE
Mailing Address - State:WI
Mailing Address - Zip Code:54525-0084
Mailing Address - Country:US
Mailing Address - Phone:715-561-2491
Mailing Address - Fax:
Practice Address - Street 1:502 COPPER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1385
Practice Address - Country:US
Practice Address - Phone:715-561-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1481-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40577100Medicaid