Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 07440 | MD |
NPI | 1720462518 |
---|---|
Provider Name | Brian P Johnson |
First Address | Baltimore, MD 21201-1082 |
Second Address | Baltimore, MD 21205-1832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2015 |
Last Update Date | 12/07/2015 |