Provider Demographics
NPI:1902382393
Name:CHAMPEAU, JULIE ELIZABETH (OTR, IBCLC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ELIZABETH
Last Name:CHAMPEAU
Suffix:
Gender:
Credentials:OTR, IBCLC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:CHAMPEAU
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:2212 OAKAWANA DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3551
Mailing Address - Country:US
Mailing Address - Phone:863-255-3293
Mailing Address - Fax:
Practice Address - Street 1:2212 OAKAWANA DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3551
Practice Address - Country:US
Practice Address - Phone:863-255-3293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008207225X00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist