Provider Demographics
NPI:1144563982
Name:KIM, JULIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KIM
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 1:2446 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3035
Mailing Address - Country:US
Mailing Address - Phone:818-298-6122
Mailing Address - Fax:
Practice Address - Street 1:1220 N 45TH ST
Practice Address - Street 2:315
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6685
Practice Address - Country:US
Practice Address - Phone:818-298-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301839225X00000X
CA9671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist