MEDICARE: JULIANA LEE DURRETT OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	109491	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	109491	OTHER	TX	OT LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PENDING	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1306889589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA LEE DURRETT OTR

Provider Business Mailing Address
First Line	:	6467 LOST HOLLY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4940
Country	:	US
Telephone Number	:	210-561-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 VILLAGE DR
Second Line	:	SUITE 109
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5418
Country	:	US
Telephone Number	:	210-297-2725
Fax Number	:	210-297-0215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/08/2012

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