Provider Demographics
NPI:1740616234
Name:ANDREOLI, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ANDREOLI
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 1:3811 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-5536
Mailing Address - Country:US
Mailing Address - Phone:262-925-9438
Mailing Address - Fax:
Practice Address - Street 1:6109 BRAUN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9409
Practice Address - Country:US
Practice Address - Phone:262-977-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR343742225X00000X
WI5714-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR343742OtherOCCUPATIONAL THERAPY LICENSE
WI5714-26OtherOCCUPATIONAL THERAPY LICENSE