Provider Demographics
NPI:1982032769
Name:DAVIDSON, JULENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULENE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 NE RAVENNA BLVD
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2532
Mailing Address - Country:US
Mailing Address - Phone:206-729-9949
Mailing Address - Fax:206-729-5077
Practice Address - Street 1:1510 NE RAVENNA BLVD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2532
Practice Address - Country:US
Practice Address - Phone:206-729-9949
Practice Address - Fax:206-729-5077
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000420171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor