Provider Demographics
NPI:1659617165
Name:BASTIAN, JULIA TAYLOR (MED, OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:TAYLOR
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:MED, OTR/L
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4180 LOUISIANA ST
Mailing Address - Street 2:APT.1A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11838 BERNARDO PLAZA CT
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2413
Practice Address - Country:US
Practice Address - Phone:858-673-5437
Practice Address - Fax:858-673-5434
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA13071225X00000X
NY017583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist