Provider Demographics
NPI:1720128762
Name:BRAZIL, JULIE GOGGINS (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:GOGGINS
Last Name:BRAZIL
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:GOGGINS
Other - Last Name:SOBKOVIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:1434 FERN CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9609
Mailing Address - Country:US
Mailing Address - Phone:501-772-6667
Mailing Address - Fax:501-221-3870
Practice Address - Street 1:1500 WILSON LOOP
Practice Address - Street 2:
Practice Address - City:WARD
Practice Address - State:AR
Practice Address - Zip Code:72176
Practice Address - Country:US
Practice Address - Phone:501-941-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120324721Medicaid
AR5X311OtherBLUE CROSS BLUE SHIELD
AROTR503Medicaid