Provider Demographics
NPI:1740217769
Name:SOTOMAYOR, JULIE (OTL/R)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:SOTOMAYOR
Suffix:
Gender:F
Credentials:OTL/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04740-4115
Mailing Address - Country:US
Mailing Address - Phone:207-488-9675
Mailing Address - Fax:207-488-9709
Practice Address - Street 1:163 FULLER RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:ME
Practice Address - Zip Code:04740-4115
Practice Address - Country:US
Practice Address - Phone:207-488-9675
Practice Address - Fax:207-488-9709
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME037738OtherBLUE CROSS
3089546OtherCIGNA
ME0002887Medicare PIN