Provider Demographics
NPI:1851552004
Name:FERGUSON, JULIE M
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:M
Last Name:FERGUSON
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 1:104 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2636
Mailing Address - Country:US
Mailing Address - Phone:509-573-5064
Mailing Address - Fax:509-573-5010
Practice Address - Street 1:104 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2636
Practice Address - Country:US
Practice Address - Phone:509-573-5064
Practice Address - Fax:509-573-5010
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003063314000000X
WAOT 00003063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility