Provider Demographics
NPI:1699848762
Name:SPOCK, JULIA SCOLNICK
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:SCOLNICK
Last Name:SPOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LYNN
Other - Last Name:SCOLNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-672-9936
Practice Address - Street 1:2801 LANCASTER AVE STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-5232
Practice Address - Country:US
Practice Address - Phone:302-778-0810
Practice Address - Fax:302-778-0812
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000045225XH1200X, 225XP0200X
PAOC002956L225XH1200X
MD02080225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934527OtherCAQH
11934527OtherCAQH