Healthcare Provider Details

I. General information

NPI: 1194632877
Provider Name (Legal Business Name): JULIA FRIEDRICH OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA CORELLO

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 KIRTS BLVD STE 107
TROY MI
48084-4141
US

IV. Provider business mailing address

12366 CONE DR
SHELBY TWP MI
48315-5702
US

V. Phone/Fax

Practice location:
  • Phone: 248-817-2484
  • Fax: 248-457-5490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014643
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: