Provider Demographics
NPI:1265268346
Name:PAINTER, JULIE (MOT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PAINTER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 PROFESSIONAL PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2049
Mailing Address - Country:US
Mailing Address - Phone:208-359-9570
Mailing Address - Fax:
Practice Address - Street 1:700 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420-5105
Practice Address - Country:US
Practice Address - Phone:208-359-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-3328225X00000X
IDOT-2170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist