Individual
JULIA WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 N JACKSON ST STE 203, MEDIA, PA 19063-2574
(484) 444-2285
Mailing address
600 N JACKSON ST STE 203, MEDIA, PA 19063-2574
(484) 444-2285
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
TOC103564
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TOC103564
STATE LIC
PA
Enumeration date
05/09/2019
Last updated
05/09/2019
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