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NPI Code Detail

MEDICARE: TREGG JOHNSON

MEDICARE: TREGG JOHNSON
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
1224Z00000XOccupational Therapy Assistant2624NM
2224Z00000XOccupational Therapy Assistant0131000941VA

General Provider Information

NPI Number : 1134405673
Entity Type Code : Individual
Provider Name (Legal Business Name) : TREGG JOHNSON
Provider Business Mailing Address
First Line : 119 W TUPPER ST
Second Line :
City : BUFFALO
State : NY
Zip : 14201-2142
Country : US
Telephone Number : 716-853-5010
Fax Number : 716-853-5020
Provider Business Practice Location Address
First Line : 119 W TUPPER ST
Second Line :
City : BUFFALO
State : NY
Zip : 14201-2142
Country : US
Telephone Number : 716-853-5010
Fax Number : 716-853-5020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2011
Last Update Date : 10/28/2011

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Directions to “ TREGG JOHNSON ” Practice Location

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