Provider Demographics
NPI:1205332723
Name:GROLEAU, JULIA WISE (MS OT R/L)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:WISE
Last Name:GROLEAU
Suffix:
Gender:F
Credentials:MS OT R/L
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MCDANIEL
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SACKETS HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:13685-9535
Mailing Address - Country:US
Mailing Address - Phone:603-781-1187
Mailing Address - Fax:
Practice Address - Street 1:420 GAFFNEY DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1823
Practice Address - Country:US
Practice Address - Phone:315-836-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist