Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 10779 | FL |
NPI | 1023392024 |
---|---|
Provider Name | Mrs. Lori Jeanne Tucker Johnson |
First Address | Coconut Creek, FL 33073-1954 |
Second Address | Coconut Creek, FL 33073-1954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2011 |
Last Update Date | 10/10/2011 |