Individual provider Active NPI

Julie Ann Ellenberger, OTR/L

  • Hand Occupational Therapist
  • Issaquah, WA
National Provider Identifier
1215283502
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hand Occupational TherapistTaxonomy code 225XH1200X
License
OT60302480 Issued in WA
Practice address
510 8TH Ave NE Ste 340
Issaquah, WA 98029-5449
Phone
(425) 313-3055
Fax
(425) 313-3051
NPI assigned
Jul 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT60302480 WA
Hand Occupational Therapist 225XH1200X OT60302480 WA Primary

Addresses

Primary practice location

510 8TH Ave NE Ste 340
Issaquah, WA 98029-5449

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (425) 313-3055

Other identifiers 1

IdentifierTypeStateIssuer
2105652MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT60302480WAMDHand Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc., P.S. Occupational Therapist CurrentSince Aug 15, 2012 Accepting new patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S CurrentSince Aug 15, 2012 Accepting new patients

Locations

1200 112th Ave NE
Ste C260
Bellevue, WA 98004
Phone (425) 313-3055

510 8th Ave NE
Ste 340
Issaquah, WA 98029
Phone (425) 313-3051

510 8th Ave NE
Ste 320
Issaquah, WA 98029

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1215283502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 320",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "425-313-3055",
            "fax_number": "425-313-3051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 340",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295449",
            "telephone_number": "425-313-3055",
            "fax_number": "425-313-3051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBERGER",
        "first_name": "JULIE",
        "middle_name": "ANN",
        "name_prefix": "Miss",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-24",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT60302480",
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "WA",
            "license": "OT60302480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2105652",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.