Healthcare Provider Details

I. General information

NPI: 1740251768
Provider Name (Legal Business Name): SUSAN FRANCES JOHNSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 385
FPO AE ITALY
09636
IT

IV. Provider business mailing address

PSC 836 BOX 385
FPO AE
09636
IT

V. Phone/Fax

Practice location:
  • Phone: 011039095306874
  • Fax: 01139095306874
Mailing address:
  • Phone: 01139095306874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT360
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: