Provider Demographics
NPI:1861630147
Name:URBANICK, JULIE ANNE (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:URBANICK
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 1:27525 ENTERPRISE CIRCLE WEST #101C
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590
Mailing Address - Country:US
Mailing Address - Phone:951-676-7693
Mailing Address - Fax:951-676-7830
Practice Address - Street 1:27525 ENTERPRISE CIR W STE 101C
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4885
Practice Address - Country:US
Practice Address - Phone:951-676-7693
Practice Address - Fax:951-676-7830
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist