MEDICARE: JULIA E TEAGUE 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	8516	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548508484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA E TEAGUE OTR

Provider Business Mailing Address
First Line	:	3727 ROSE LAKE DR
Second Line	:	SUITE 103
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2846
Country	:	US
Telephone Number	:	704-778-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 ROSE LAKE DR
Second Line	:	SUITE 103
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2846
Country	:	US
Telephone Number	:	704-778-7192
Fax Number	:

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

Provider Enumeration Date	:	01/28/2013
Last Update Date	:	01/28/2013

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Directions to “ JULIA E TEAGUE OTR” Practice Location

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