Provider Demographics
NPI:1316421241
Name:KORN, JULIE ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:KORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:SHAFER-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:17902 AARON CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-7774
Mailing Address - Country:US
Mailing Address - Phone:214-794-3650
Mailing Address - Fax:
Practice Address - Street 1:17902 AARON CREEK WAY
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-7774
Practice Address - Country:US
Practice Address - Phone:214-794-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171461225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation