Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 003049 | MO |
NPI | 1093860967 |
---|---|
Provider Name | Mr. Larry Alan Johnson |
First Address | Tulsa, OK 74133-1924 |
Second Address | Tulsa, OK 74133-1924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |