MEDICARE: JANYCE JOHNSON 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

General Provider Information

NPI Number	:	1386745065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANYCE JOHNSON OTR/L

Provider Business Mailing Address
First Line	:	1000 S FREMONT AVE
Second Line	:	SUITE 10100 UNIT 27
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-8800
Country	:	US
Telephone Number	:	626-289-7472
Fax Number	:	626-289-8620

Provider Business Practice Location Address
First Line	:	1000 S FREMONT AVE
Second Line	:	SUITE 10100 UNIT 27
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-8800
Country	:	US
Telephone Number	:	626-289-7472
Fax Number	:	626-289-8620

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	01/06/2012

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