Provider Demographics
NPI:1639152101
Name:DROMGOOLE, JULIE A (OT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:DROMGOOLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:WILKINS
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:72 WHEATHERSTONE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1955
Mailing Address - Country:US
Mailing Address - Phone:503-329-0292
Mailing Address - Fax:503-352-5555
Practice Address - Street 1:7204 SW DURHAM RD
Practice Address - Street 2:STE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-7574
Practice Address - Country:US
Practice Address - Phone:503-329-0292
Practice Address - Fax:503-352-5555
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1048049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR029052Medicaid
ORQ10587Medicare UPIN
OR029052Medicaid