Provider Demographics
NPI:1053578435
Name:WOOTERS, JULIE R (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:R
Last Name:WOOTERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COUNTRY CLUB AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-6644
Mailing Address - Country:US
Mailing Address - Phone:605-582-8421
Mailing Address - Fax:
Practice Address - Street 1:217 COUNTRY CLUB AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-6644
Practice Address - Country:US
Practice Address - Phone:605-582-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist