Provider Demographics
NPI:1972172807
Name:GUIMOND, JULIA E
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:GUIMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 W BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2344
Mailing Address - Country:US
Mailing Address - Phone:224-688-8248
Mailing Address - Fax:
Practice Address - Street 1:8702 W BRUCE DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2344
Practice Address - Country:US
Practice Address - Phone:224-688-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56012389225X00000X
IN056.012389225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist