Provider Demographics
NPI:1528493848
Name:STEVENS, JULIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:STEVENS
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 1:4620 KINGS GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4912
Mailing Address - Country:US
Mailing Address - Phone:919-423-8404
Mailing Address - Fax:
Practice Address - Street 1:4620 KINGS GARDEN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4912
Practice Address - Country:US
Practice Address - Phone:919-423-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5906172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker