Healthcare Provider Details

I. General information

NPI: 1356701841
Provider Name (Legal Business Name): JULIANNE CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 W PECOS RD APT 1058
CHANDLER AZ
85224-4837
US

IV. Provider business mailing address

2450 W PECOS RD APT 1058
CHANDLER AZ
85224-4837
US

V. Phone/Fax

Practice location:
  • Phone: 708-612-1800
  • Fax:
Mailing address:
  • Phone: 708-612-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number6489
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: