Healthcare Provider Details

I. General information

NPI: 1255067468
Provider Name (Legal Business Name): DARRIAH JOHNSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 MASSACHUSETTS AVE NW
WASHINGTON DC
20005-4155
US

IV. Provider business mailing address

3116 N ST SE
WASHINGTON DC
20019-2143
US

V. Phone/Fax

Practice location:
  • Phone: 540-520-9411
  • Fax: 847-730-2941
Mailing address:
  • Phone: 256-679-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number09719
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: