Healthcare Provider Details

I. General information

NPI: 1831254242
Provider Name (Legal Business Name): JULIE LANEE COLLINS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE LANEE PONCE OTR

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 01/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR OCCUPATIONAL THERAPY DEPT. 3RD FLOOR REHAB
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR OCCUPATIONAL THERAPY DEPT. 3RD FLOOR REHAB
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1312
  • Fax:
Mailing address:
  • Phone: 707-651-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number7628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: