Provider Demographics
NPI:1801803952
Name:HAYWOOD-BREAULT, JULIA LOUISE (OT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LOUISE
Last Name:HAYWOOD-BREAULT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6136
Mailing Address - Country:US
Mailing Address - Phone:801-292-8665
Mailing Address - Fax:
Practice Address - Street 1:280 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6136
Practice Address - Country:US
Practice Address - Phone:801-292-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109645-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist