Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119004332 | VA |
NPI | 1003108929 |
---|---|
Provider Name | Mrs. Betsy Leah Johnson |
First Address | Ashburn, VA 20147-2855 |
Second Address | Ashburn, VA 20147-2855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 11/05/2011 |