Provider Demographics
NPI:1982111696
Name:MIKOLAICHIK, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MIKOLAICHIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:HARDING
Mailing Address - State:PA
Mailing Address - Zip Code:18643-7106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1126 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:HARDING
Practice Address - State:PA
Practice Address - Zip Code:18643-7106
Practice Address - Country:US
Practice Address - Phone:570-690-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17530225X00000X
PAOC014544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist