Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A01140 | MD |
NPI | 1033318159 |
---|---|
Provider Name | Mr. Donald Jeffrey Johnson |
First Address | Abingdon, MD 21009-2979 |
Second Address | Phoenix, AZ 85021-7967 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |