Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 111037 | TX |
NPI | 1083743462 |
---|---|
Provider Name | Mrs. Michelle Melito Johnson |
First Address | The Woodlands, TX 77382-1788 |
Second Address | Conroe, TX 77385-8744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T2888 | BCBS (01) | TX |