Provider Demographics
NPI:1962257782
Name:BYNUM, JULIA (OTD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 CLUB WEST PARKWAY NE, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10961 CLUB WEST PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5869
Practice Address - Country:US
Practice Address - Phone:763-528-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand