Individual
MRS. JULIE CALLICUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., E.I., ITFS
Contact information
Practice address
5307 BROADMOOR PL, GREENSBORO, NC 27410-3420
(336) 908-4151
Mailing address
PO BOX 4033, GREENSBORO, NC 27404-4033
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8200082K
—
NC
Enumeration date
06/26/2007
Last updated
02/04/2012
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