Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 01386 | MD |
NPI | 1174117881 |
---|---|
Provider Name | Mrs. Doris Wilson Johnson |
First Address | Fulton, MD 20759-9637 |
Second Address | Severna Park, MD 21146-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |