Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1673 | OK |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1673 | OK |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1673 | OK |
NPI | 1164709598 |
---|---|
Provider Name | Whitney Anne Johnson |
First Address | Waurika, OK 73573-3008 |
Second Address | Waurika, OK 73573-3008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 03/04/2017 |