MEDICARE: MS. ELEONORE MAE 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	OC008971	PA

General Provider Information

NPI Number	:	1427048131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELEONORE MAE JOHNSON OTR/L

Provider Business Mailing Address
First Line	:	7950 MARTIN LOOP
Second Line	:	OCCUPATIONAL THERAPY CLINIC
City	:	COLUMBUS
State	:	GA
Zip	:	31905-5648
Country	:	US
Telephone Number	:	706-544-1389
Fax Number	:	706-544-4059

Provider Business Practice Location Address
First Line	:	7950 MARTIN LOOP
Second Line	:	OCCUPATIONAL THERAPY CLINIC
City	:	COLUMBUS
State	:	GA
Zip	:	31905-5648
Country	:	US
Telephone Number	:	706-544-1389
Fax Number	:	706-544-4059

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/13/2012

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