Provider Demographics
NPI:1053558007
Name:DITSCHEIT, JULIANNE GRIEP (OTRL)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:GRIEP
Last Name:DITSCHEIT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1828
Mailing Address - Country:US
Mailing Address - Phone:414-258-7705
Mailing Address - Fax:
Practice Address - Street 1:2371 N 90TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1828
Practice Address - Country:US
Practice Address - Phone:414-258-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1631-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist