MEDICARE: JULIANNA ELISE DOLE 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
1	225X00000X	Occupational Therapist	23006	CA

General Provider Information

NPI Number	:	1386395267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNA ELISE DOLE OTR/L

Provider Business Mailing Address
First Line	:	27657 RON RIDGE DR
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-4338
Country	:	US
Telephone Number	:	661-361-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	24070 COPPER HILL DR
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91354-4402
Country	:	US
Telephone Number	:	661-361-3606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	01/12/2022

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