Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | TN |
NPI | 1548305501 |
---|---|
Provider Name | Norma Jean Johnson |
First Address | Tiptonville, TN 38079-1359 |
Second Address | Tiptonville, TN 38079-1359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 30/11/2013 |