Provider Demographics
NPI:1306124326
Name:HILDEBRANDT, JULIE A (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:HILDEBRANDT
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 1:2312 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2118
Mailing Address - Country:US
Mailing Address - Phone:402-305-8838
Mailing Address - Fax:
Practice Address - Street 1:2312 S 88TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2118
Practice Address - Country:US
Practice Address - Phone:402-305-8838
Practice Address - Fax:402-323-0166
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1060225XP0019X
IA001817225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000798Medicaid
NE1060Medicaid