Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 12501 | NC |
NPI | 1023676087 |
---|---|
Provider Name | Catherine Ireland Johnson |
First Address | Charlotte, NC 28226-7225 |
Second Address | Waxhaw, NC 28173-6950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 16/09/2021 |