Healthcare Provider Details

I. General information

NPI: 1245568203
Provider Name (Legal Business Name): JULINA MICHELLE SMITH OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULINA MICHELLE LAMBSON OT/L

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 13TH ST STE G90
COLUMBUS IN
47201
US

IV. Provider business mailing address

437 HIGHLAND DR
GREENWOOD IN
46142
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-1758
  • Fax: 765-448-3898
Mailing address:
  • Phone: 765-376-2726
  • Fax: 765-448-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31003856A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31003856A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: