Provider Demographics
NPI:1578703260
Name:BROWN, JULIE RAE (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23200 NE SANDY BLVD UNIT 17
Mailing Address - Street 2:
Mailing Address - City:WOOD VILLAGE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-9607
Mailing Address - Country:US
Mailing Address - Phone:503-665-1151
Mailing Address - Fax:503-491-1651
Practice Address - Street 1:5905 SE POWELL VALLEY RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1919
Practice Address - Country:US
Practice Address - Phone:503-665-1151
Practice Address - Fax:503-491-1651
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6596224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant