Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1780731984 |
---|---|
Provider Name | Mrs. Leann Marie Johnson |
First Address | Parma, OH 44134-3769 |
Second Address | Parma, OH 44134-3769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100587 | KAISER PERMANENTE (01) | OH |
341425661-00 | WORKERS COMP (01) | OH |
341425661-004 | MEDICAL MUTUAL (01) | OH |
6725208 | (05) | OH |