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General NPI Number Information
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NPI Number | 1083743462
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Entity Type | Individual
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Provider Name | MICHELLE MELITO JOHNSON OTR, CHT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 19073 INTERSTATE 45 S STE 145
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City | CONROE
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State | TX
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Zip | 77385-8744
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Country | US
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Telephone | 936-321-4700
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Fax | 936-321-4848
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Provider Business Mailing Address
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Address Line | 22 S PENTENWELL CIR
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City | THE WOODLANDS
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State | TX
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Zip | 77382-1788
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Country | US
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Telephone | 281-298-6404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 111037
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License Number State | TX
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