Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 02417 | OH |
NPI | 1003855834 |
---|---|
Provider Name | Mr. Garlen Leo Johnson JR. |
First Address | Ironton, OH 45638-1057 |
Second Address | Huntington, WV 25704-9300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/07/2007 |