Provider Demographics
NPI:1174509830
Name:BRODY, JULIE A (OT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BRODY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:INNERST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:14348 GIDEON DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4640
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8732
Practice Address - Street 1:14348 GIDEON DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4640
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-878-8732
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001308225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ20232Medicare UPIN
PA081333D1XMedicare ID - Type Unspecified