Provider Demographics
NPI:1770607277
Name:PETERSON, JULIE ANNE (OTR)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:416 RONDELAY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9223
Mailing Address - Country:US
Mailing Address - Phone:919-596-3586
Mailing Address - Fax:
Practice Address - Street 1:416 RONDELAY DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9223
Practice Address - Country:US
Practice Address - Phone:919-596-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0145225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139CTOtherBCBS PROVIDER #