Provider Demographics
NPI:1306889589
Name:DURRETT, JULIANA LEE (OTR)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:LEE
Last Name:DURRETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6467 LOST HOLLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4940
Mailing Address - Country:US
Mailing Address - Phone:210-561-1380
Mailing Address - Fax:
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-297-2725
Practice Address - Fax:210-297-0215
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109491225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109491OtherOT LICENSE
TXPENDINGMedicaid
TXPENDINGOtherBLUE CROSS
TX109491OtherOT LICENSE
TXPENDINGMedicaid