Healthcare Provider Details

I. General information

NPI: 1386671782
Provider Name (Legal Business Name): SUE ANN JOHNSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 SPRING ST #1
FRIDAY HARBOR WA
98250-9376
US

IV. Provider business mailing address

486 BYRON RD
FRIDAY HARBOR WA
98250-6967
US

V. Phone/Fax

Practice location:
  • Phone: 360-370-5226
  • Fax: 360-370-5559
Mailing address:
  • Phone: 360-378-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00002660
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: