Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 07528 | MD |
N | 225X00000X | Occupational Therapist | 114800 | TX |
N | 225X00000X | Occupational Therapist | 15251 | FL |
NPI | 1003177080 |
---|---|
Provider Name | Tonika Johnson |
First Address | Lauderhill, FL 33319-7317 |
Second Address | Port Orange, FL 32128-8311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 20/12/2018 |