Basic Information
| Provider Information | |||||||||
| NPI: | 1770778854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAY | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1152 HIGHWAY ALT 2 | ||||||||
| Address2: | |||||||||
| City: | SHONGALOO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710722862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186248530 | ||||||||
| FaxNumber: | 3186248530 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 REYNOLDS ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710753444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185394006 | ||||||||
| FaxNumber: | 3185394008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 09/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Z11094 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.