Provider Demographics
NPI:1780101899
Name:WALTENBURG, JULIANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:WALTENBURG
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 1:1122 N 6TH ST APT 17
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1650
Mailing Address - Country:US
Mailing Address - Phone:775-741-0485
Mailing Address - Fax:
Practice Address - Street 1:4636 E MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2382
Practice Address - Country:US
Practice Address - Phone:206-763-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61138507225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics