Provider Demographics
NPI:1477160950
Name:JULIANA, MICHAELA (OT/L, CAPS)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:JULIANA
Suffix:
Gender:F
Credentials:OT/L, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RIPLEY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5121
Mailing Address - Country:US
Mailing Address - Phone:919-469-1191
Mailing Address - Fax:
Practice Address - Street 1:104 RIPLEY CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5121
Practice Address - Country:US
Practice Address - Phone:919-469-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 225XE0001X
NC0628225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist