Provider Demographics
NPI:1881719003
Name:HENDERSON, JULIE KAY (OTL, CHT)
Entity type:Individual
Prefix:MR
First Name:JULIE
Middle Name:KAY
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OTL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13514 ACACIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-3249
Mailing Address - Country:US
Mailing Address - Phone:763-878-1648
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 400
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2776
Practice Address - Country:US
Practice Address - Phone:763-236-8911
Practice Address - Fax:763-236-8930
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100914225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand