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NPI Code Detail

MEDICARE: JULIA PASSUTH OTR/L

MEDICARE: JULIA PASSUTH OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist0119010397VA

General Provider Information

NPI Number : 1255187480
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA PASSUTH OTR/L
Provider Business Mailing Address
First Line : 3019 TAYLOR MAKENZYE CT
Second Line :
City : HERNDON
State : VA
Zip : 20171-4074
Country : US
Telephone Number : 571-426-4404
Fax Number :
Provider Business Practice Location Address
First Line : 14901 BOGLE DR STE 100
Second Line :
City : CHANTILLY
State : VA
Zip : 20151-1736
Country : US
Telephone Number : 571-346-3781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2024
Last Update Date : 04/29/2024

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