Basic Information
Provider Information
NPI: 1154645612
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JENKINS
FirstName: JULIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1241 N MAIN ST
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 228024632
CountryCode: US
TelephoneNumber: 5404341941
FaxNumber:  
Practice Location
Address1: 463 E WASHINGTON ST
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 228024853
CountryCode: US
TelephoneNumber: 5404341941
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/26/2010
LastUpdateDate: 05/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X0119004938VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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