Provider Demographics
NPI:1710010806
Name:FLETCHER, JULIE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5660
Mailing Address - Country:US
Mailing Address - Phone:610-805-9500
Mailing Address - Fax:
Practice Address - Street 1:177 MARY AVE
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5660
Practice Address - Country:US
Practice Address - Phone:805-600-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9310225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist