Healthcare Provider Details

I. General information

NPI: 1215203153
Provider Name (Legal Business Name): JULIE PALANA WIERZBA MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 12/30/2021
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RICHMOND DR APT 12
MILLBRAE CA
94030-1632
US

IV. Provider business mailing address

400 RICHMOND DR APT 12
MILLBRAE CA
94030-1632
US

V. Phone/Fax

Practice location:
  • Phone: 650-296-6629
  • Fax:
Mailing address:
  • Phone: 650-296-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT13737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: