MEDICARE: JULIE STEPHENSON ROYAL 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	5201003040	MI

General Provider Information

NPI Number	:	1407046980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE STEPHENSON ROYAL OTR

Provider Business Mailing Address
First Line	:	36 BELLEVIEW ST
Second Line	:
City	:	MOUNT CLEMENS
State	:	MI
Zip	:	48043-2241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 1ST ST N STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6939
Country	:	US
Telephone Number	:	904-241-9231
Fax Number	:

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

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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Directions to “ JULIE STEPHENSON ROYAL OTR” Practice Location

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