Healthcare Provider Details

I. General information

NPI: 1437334612
Provider Name (Legal Business Name): ALLISON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST GEORGE CLINIC
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST HASBRO 122
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3201
  • Fax:
Mailing address:
  • Phone: 401-444-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01161
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: