Provider Demographics
NPI:1184788499
Name:BRANNON, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRANNON
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:ATTN CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:USA
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:49622-117-2941
Practice Address - Street 1:ATTN CREDENTIALS OFFICE
Practice Address - Street 2:CMR 442
Practice Address - City:APO
Practice Address - State:USA
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:49622-117-2274
Practice Address - Fax:49622-117-2941
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist