Basic Information
| Provider Information | |||||||||
| NPI: | 1699226126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNSON | ||||||||
| FirstName: | JULIA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 HILLRISE CIR | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880114759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755229528 | ||||||||
| FaxNumber: | 5755231108 | ||||||||
| Practice Location | |||||||||
| Address1: | 12371 S KIRKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139959292 | ||||||||
| FaxNumber: | 7137790204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2016 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 117854 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 3351 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.