Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT005185 | GA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT005185 | GA |
NPI | 1164962437 |
---|---|
Provider Name | Kristen Julian |
First Address | Milton, GA 30004-8835 |
Second Address | Milton, GA 30004-8835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 29/11/2021 |