Provider Demographics
NPI:1316125636
Name:DESHONG, JULIE HASTINGS (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:HASTINGS
Last Name:DESHONG
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:PO BOX 891
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-0891
Mailing Address - Country:US
Mailing Address - Phone:410-571-6411
Mailing Address - Fax:410-571-6415
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 232
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-571-6411
Practice Address - Fax:410-571-6415
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist