Healthcare Provider Details

I. General information

NPI: 1841569100
Provider Name (Legal Business Name): JULIE M SHATTUCK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 WINDFALL RD
OLEAN NY
14760-9333
US

IV. Provider business mailing address

7831 E FLATS RD
EAST OTTO NY
14729-9797
US

V. Phone/Fax

Practice location:
  • Phone: 716-376-8201
  • Fax:
Mailing address:
  • Phone: 716-257-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number011149-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: