Provider Demographics
NPI:1104491497
Name:LEPAGE, JULIE MARIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FRIENDSHIP AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4705
Mailing Address - Country:US
Mailing Address - Phone:401-263-4457
Mailing Address - Fax:
Practice Address - Street 1:800 QUAKER LN
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1667
Practice Address - Country:US
Practice Address - Phone:401-886-6600
Practice Address - Fax:401-886-6632
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant