MEDICARE: MS. JULIE DENICIA ERB O.T.R.

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	104500	TX
2	225XP0200X	Pediatric Occupational Therapist	104500	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801891445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE DENICIA ERB O.T.R.

Provider Business Mailing Address
First Line	:	432 OAK ST
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-2522
Country	:	US
Telephone Number	:	940-549-0788
Fax Number	:	940-549-0788

Provider Business Practice Location Address
First Line	:	432 OAK ST
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-2522
Country	:	US
Telephone Number	:	940-549-0788
Fax Number	:	940-549-0788

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	01/18/2013

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