Provider Demographics
NPI:1447550280
Name:WADE, JULIE ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:WADE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ELIZABETH
Other - Last Name:RUSZCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:54 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1327
Mailing Address - Country:US
Mailing Address - Phone:716-713-0275
Mailing Address - Fax:
Practice Address - Street 1:54 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1327
Practice Address - Country:US
Practice Address - Phone:716-713-0275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist