Provider Demographics
NPI:1255777058
Name:DANIELS, JULIE THERESA (OT)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:THERESA
Last Name:DANIELS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M230
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-8601
Mailing Address - Fax:269-349-6446
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M230
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-8601
Practice Address - Fax:269-349-6446
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist