Provider Demographics
NPI:1770042285
Name:BROTT, JULIA ANNE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:BROTT
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 1:1850 52ND ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9601
Mailing Address - Country:US
Mailing Address - Phone:231-670-5140
Mailing Address - Fax:
Practice Address - Street 1:1850 52ND ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9601
Practice Address - Country:US
Practice Address - Phone:231-670-5140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202002694224Z00000X
CA4062224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant