MEDICARE: ELIZABETH 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	31005764A	IN

General Provider Information

NPI Number	:	1750692406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JOHNSON OTR-L

Provider Business Mailing Address
First Line	:	2920 10TH ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6602
Country	:	US
Telephone Number	:	812-376-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 10TH ST
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-6602
Country	:	US
Telephone Number	:	812-376-9404
Fax Number	:

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	09/27/2019

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