1922652130 NPI number — MS. JULIE LYNN MILASICH OTR/L, CHT

Table of content: MS. JULIE LYNN MILASICH OTR/L, CHT (NPI 1922652130)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922652130 NPI number — MS. JULIE LYNN MILASICH OTR/L, CHT

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MILASICH

Provider First Name:
JULIE

Provider Middle Name:
LYNN

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
OTR/L, CHT

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
DENNIS

Provider Other First Name:
JULIE

Provider Other Middle Name:
LYNN

Provider Other Name Prefix Text:
MS.

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922652130

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/25/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5928 N 28TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
TACOMA

Provider Business Mailing Address State Name:
WA

Provider Business Mailing Address Postal Code:
98407-2350

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
253-460-0966

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4970 AUTO CENTER WAY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
BREMERTON

Provider Business Practice Location Address State Name:
WA

Provider Business Practice Location Address Postal Code:
98312-3328

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
360-627-7768

Provider Business Practice Location Address Fax Number:
360-627-8003

Provider Enumeration Date:
07/25/2019

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: 225XH1200X , with the licence number: 00003194 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 225X00000X , with the licence number: 00003194 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .