Provider Demographics
NPI:1669792628
Name:ANICH, JULIE ANN (OTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:ANICH
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:2330 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2510
Mailing Address - Country:US
Mailing Address - Phone:414-507-8011
Mailing Address - Fax:
Practice Address - Street 1:2330 S 86TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2510
Practice Address - Country:US
Practice Address - Phone:414-507-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86 - 27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI081 187OtherWISCONSIN DPI LICENSE