Healthcare Provider Details

I. General information

NPI: 1568874063
Provider Name (Legal Business Name): ANDRE CHRISTOPHER JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 S OTHELLO ST STE 101
SEATTLE WA
98118-3505
US

IV. Provider business mailing address

3939 S OTHELLO ST STE 101
SEATTLE WA
98118-3505
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-7210
  • Fax:
Mailing address:
  • Phone: 206-987-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA 11467
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61590546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: