MEDICARE: PAYTON JOHNSON MOT

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	0119009908	VA

General Provider Information

NPI Number	:	1477257418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON JOHNSON MOT

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2307
Country	:	US
Telephone Number	:	888-830-4125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7225 BELL CREEK RD STE 256B
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3503
Country	:	US
Telephone Number	:	804-486-6860
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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