1306342027 NPI number — JULIA BARTLETT OTR

Table of content: JULIA BARTLETT OTR (NPI 1306342027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306342027 NPI number — JULIA BARTLETT OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTLETT
Provider First Name:
JULIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306342027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/11/2021
NPI Reactivation Date:
06/01/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 N ADAMS ST STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68046-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-916-4539
Provider Business Mailing Address Fax Number:
402-403-5857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 SW 59TH ST STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73109-8324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-355-3239
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5586 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)