Individual
MS. JULIA ICENOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
18151 68TH AVE NE STE 100, KENMORE, WA 98028-2835
(425) 686-6760
(425) 686-6763
Mailing address
18151 68TH AVE NE STE 100, KENMORE, WA 98028-2835
(425) 686-6760
(425) 686-6763
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT 60399402
WA
225XH1200X
Hand Occupational Therapist
Primary
312111
OR
Other
Enumeration date
01/20/2014
Last updated
07/02/2024
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