MEDICARE: CARRIE SUE JOHNSTON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119001043	VA

General Provider Information

NPI Number	:	1053816603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE SUE JOHNSTON OTR/L

Provider Business Mailing Address
First Line	:	315 NAPLES CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-8378
Country	:	US
Telephone Number	:	757-714-0148
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 HANBURY RD W
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-4226
Country	:	US
Telephone Number	:	757-714-0148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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