Provider Demographics
NPI:1255619938
Name:SILLAMAN, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SILLAMAN
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 1:22265 N 102ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10025 W ROYAL OAK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3102
Practice Address - Country:US
Practice Address - Phone:623-815-4156
Practice Address - Fax:623-815-4146
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist