MEDICARE: DR. JOHNNY R OCONNOR JR. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	19003	TX

General Provider Information

NPI Number	:	1215298690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY R OCONNOR JR. CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 535
Second Line	:
City	:	CHANNELVIEW
State	:	TX
Zip	:	77530-0535
Country	:	US
Telephone Number	:	832-414-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	14438 COTTAGE TIMBERS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4446
Country	:	US
Telephone Number	:	832-414-9701
Fax Number	:

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

Provider Enumeration Date	:	06/02/2012
Last Update Date	:	06/02/2012

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Directions to “ DR. JOHNNY R OCONNOR JR. CCC-SLP” Practice Location

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