Healthcare Provider Details

I. General information

NPI: 1841439601
Provider Name (Legal Business Name): WILLIAM MICHAEL JOHNSON OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 RACE TRACK RD SUITE 100
TAMPA FL
33626-3102
US

IV. Provider business mailing address

3202 OTTOGAN ST
HUDSONVILLE MI
49426-9647
US

V. Phone/Fax

Practice location:
  • Phone: 866-416-5202
  • Fax:
Mailing address:
  • Phone: 616-250-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201007497
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: