Provider Demographics
NPI:1659421147
Name:TABERMAN, JULIA ARDELLE (OT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ARDELLE
Last Name:TABERMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PARK LN
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2911
Mailing Address - Country:US
Mailing Address - Phone:617-524-7305
Mailing Address - Fax:
Practice Address - Street 1:19 PARK LN
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-2911
Practice Address - Country:US
Practice Address - Phone:617-524-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist