Healthcare Provider Details

I. General information

NPI: 1356320642
Provider Name (Legal Business Name): JULIE MACLEAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JULIE BURKE

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HIGH STREET
MEDFORD MA
02155
US

IV. Provider business mailing address

84 HIGH STREET
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-391-0303
  • Fax:
Mailing address:
  • Phone: 781-391-0303
  • Fax: 781-391-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: