Provider Demographics
NPI:1972963338
Name:EWALD, JULIE (MA/OTRL)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EWALD
Suffix:
Gender:F
Credentials:MA/OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-5103
Mailing Address - Country:US
Mailing Address - Phone:207-767-3949
Mailing Address - Fax:
Practice Address - Street 1:7 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-5103
Practice Address - Country:US
Practice Address - Phone:207-767-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2016-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT561225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics