Provider Demographics
NPI:1508685124
Name:HAZEN, JULIA KATE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KATE
Last Name:HAZEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2831
Mailing Address - Country:US
Mailing Address - Phone:909-767-2379
Mailing Address - Fax:
Practice Address - Street 1:4211 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3502
Practice Address - Country:US
Practice Address - Phone:951-340-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27012225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics