Provider Demographics
NPI:1306808076
Name:SIEBENBERG, JULIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:SIEBENBERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:14109 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1936
Mailing Address - Country:US
Mailing Address - Phone:718-820-9339
Mailing Address - Fax:718-820-9339
Practice Address - Street 1:7014 141ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1931
Practice Address - Country:US
Practice Address - Phone:718-851-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0053341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist