Provider Demographics
NPI:1619278264
Name:STAMM, JULIE MARIE (ATC)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARIE
Last Name:STAMM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:SASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:6411 BRIDGE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1806
Mailing Address - Country:US
Mailing Address - Phone:715-573-5626
Mailing Address - Fax:
Practice Address - Street 1:6411 BRIDGE RD APT 1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1806
Practice Address - Country:US
Practice Address - Phone:715-573-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer