Provider Demographics
NPI:1437571890
Name:ICENOGLE, JULIA (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:ICENOGLE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18151 68TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-2835
Mailing Address - Country:US
Mailing Address - Phone:425-686-6760
Mailing Address - Fax:425-686-6763
Practice Address - Street 1:18151 68TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-2835
Practice Address - Country:US
Practice Address - Phone:425-686-6760
Practice Address - Fax:425-686-6763
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR312111225XH1200X
WAOT 60399402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist