Healthcare Provider Details

I. General information

NPI: 1851622526
Provider Name (Legal Business Name): JULIANNE M HEGEMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17311 135TH AVE NE C200
WOODINVILLE WA
98072-3519
US

IV. Provider business mailing address

3602 23RD AVE W
SEATTLE WA
98199-2332
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-7710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00004463
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: