Provider Demographics
NPI:1588425482
Name:SMITH, JULIE ELIZABETH (TVI/O&M)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:TVI/O&M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12521 AVENUE DUBOIS SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5242
Mailing Address - Country:US
Mailing Address - Phone:253-720-9274
Mailing Address - Fax:
Practice Address - Street 1:12521 AVENUE DUBOIS SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-5242
Practice Address - Country:US
Practice Address - Phone:253-720-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA500498A2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, BlindGroup - Multi-Specialty