Provider Demographics
NPI:1700409091
Name:BERCAW, JULIA PAIGE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:PAIGE
Last Name:BERCAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S 47TH ST APT 301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3652
Mailing Address - Country:US
Mailing Address - Phone:908-752-7299
Mailing Address - Fax:
Practice Address - Street 1:17 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:PITTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08867-4028
Practice Address - Country:US
Practice Address - Phone:908-752-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK161450225X00000X
PAOC017251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist