Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | R3240 | KY |
NPI | 1003031667 |
---|---|
Provider Name | Tabitha Johnson |
First Address | Germantown, KY 41044-9074 |
Second Address | Mayslick, KY 41055-8930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |