Provider Demographics
NPI:1730647173
Name:SMUCZYNSKI, JULIE ANN
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SMUCZYNSKI
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 1:7738 GARDNER DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2608
Mailing Address - Country:US
Mailing Address - Phone:239-594-0787
Mailing Address - Fax:
Practice Address - Street 1:900 IMPERIAL GOLF COURSE BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1085
Practice Address - Country:US
Practice Address - Phone:239-591-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty