Provider Demographics
NPI:1144437773
Name:HAREN, JULIE ANN (AT C,L)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:HAREN
Suffix:
Gender:F
Credentials:AT C,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8859
Mailing Address - Country:US
Mailing Address - Phone:330-454-6863
Mailing Address - Fax:
Practice Address - Street 1:6200 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7624
Practice Address - Country:US
Practice Address - Phone:330-966-8920
Practice Address - Fax:330-966-8898
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer