Healthcare Provider Details

I. General information

NPI: 1215283502
Provider Name (Legal Business Name): JULIE ANN ELLENBERGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE STE 340
ISSAQUAH WA
98029-5449
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-3055
  • Fax: 425-313-3051
Mailing address:
  • Phone: 425-313-3055
  • Fax: 425-313-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60302480
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT60302480
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: