Provider Demographics
NPI:1649695933
Name:INDA, JULIE ANNE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:INDA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3249
Mailing Address - Country:US
Mailing Address - Phone:217-875-0020
Mailing Address - Fax:217-872-1734
Practice Address - Street 1:2530 N MONROE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3249
Practice Address - Country:US
Practice Address - Phone:217-875-0020
Practice Address - Fax:217-872-1734
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056003047225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology