Provider Demographics
NPI:1902629074
Name:WIANT, JULIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WIANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1781B STONEY WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 STATE ROUTE 488
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-9308
Practice Address - Country:US
Practice Address - Phone:315-548-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021185-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist