Provider Demographics
NPI:1801231097
Name:MOSSBARGER, JULIE (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MOSSBARGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 LA DAWN LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1930
Mailing Address - Country:US
Mailing Address - Phone:404-314-5505
Mailing Address - Fax:
Practice Address - Street 1:2150 LA DAWN LN NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1930
Practice Address - Country:US
Practice Address - Phone:404-314-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist