Healthcare Provider Details

I. General information

NPI: 1316125636
Provider Name (Legal Business Name): JULIE HASTINGS DESHONG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8659 BALTIMORE NATIONAL PIKE STE A
ELLICOTT CITY MD
21043-4126
US

IV. Provider business mailing address

8659 BALTIMORE NATIONAL PIKE STE A
ELLICOTT CITY MD
21043-4126
US

V. Phone/Fax

Practice location:
  • Phone: 443-565-6638
  • Fax:
Mailing address:
  • Phone: 443-565-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number03068
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number03068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: