Provider Demographics
NPI:1649803651
Name:HUPP, JULIE ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HUPP
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 1:1350 W HAWLEY ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1504
Mailing Address - Country:US
Mailing Address - Phone:847-949-2200
Mailing Address - Fax:
Practice Address - Street 1:1350 W HAWLEY ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1519
Practice Address - Country:US
Practice Address - Phone:847-949-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001822225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist