Provider Demographics
NPI:1629582200
Name:LOEBERTMAN, JULIA MARY
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARY
Last Name:LOEBERTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 N HIGH POINT RD APT 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2814
Mailing Address - Country:US
Mailing Address - Phone:171-584-6536
Mailing Address - Fax:
Practice Address - Street 1:1044 N HIGH POINT RD APT 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2814
Practice Address - Country:US
Practice Address - Phone:715-846-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI544827224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty