Provider Demographics
NPI:1669368882
Name:NOWAK, JULIA BETH (OTD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:BETH
Last Name:NOWAK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:BETH
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2247 SISSON DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6860
Mailing Address - Country:US
Mailing Address - Phone:320-420-9244
Mailing Address - Fax:
Practice Address - Street 1:2890 OCEAN BLVD SE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3530
Practice Address - Country:US
Practice Address - Phone:541-267-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR521133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist