MEDICARE: OKEYA 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
1	106S00000X	Behavior Technician
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	222Q00000X	OTHER		FAMILY MATTERS

General Provider Information

NPI Number	:	1255966024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKEYA JOHNSON

Provider Business Mailing Address
First Line	:	1605 ELIZABETH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4138
Country	:	US
Telephone Number	:	910-574-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 ELIZABETH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4138
Country	:	US
Telephone Number	:	910-574-2031
Fax Number	:

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

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	01/25/2023

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Directions to “ OKEYA JOHNSON ” Practice Location

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