Provider Demographics
NPI:1487362950
Name:OTWELL, JULIA LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LEIGH
Last Name:OTWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2035
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-2035
Mailing Address - Country:US
Mailing Address - Phone:231-944-4478
Mailing Address - Fax:231-346-6013
Practice Address - Street 1:515 W FOURTEENTH ST UNIT A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4059
Practice Address - Country:US
Practice Address - Phone:231-944-4478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501302350OtherMICHIGAN PHYSICAL THERAPY LICENSING