Provider Demographics
NPI:1871146639
Name:HULONGBAYAN, JULIE ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HULONGBAYAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2022
Mailing Address - Country:US
Mailing Address - Phone:229-444-8593
Mailing Address - Fax:
Practice Address - Street 1:207 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-1835
Practice Address - Country:US
Practice Address - Phone:850-584-6334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15093224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant