Healthcare Provider Details

I. General information

NPI: 1801451372
Provider Name (Legal Business Name): JULIE PARSON OTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 GROVE WALK CT
NOBLESVILLE IN
46062-8033
US

IV. Provider business mailing address

6202 GROVE WALK CT
NOBLESVILLE IN
46062-8033
US

V. Phone/Fax

Practice location:
  • Phone: 317-517-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011068A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: