Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | AOO558 | MD |
NPI | 1003030909 |
---|---|
Provider Name | Jonathan David Johnson |
First Address | Baltimore, MD 21236-4808 |
Second Address | Baltimore, MD 21218-5128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |