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General NPI Number Information
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NPI Number | 1093860967
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Entity Type | Individual
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Provider Name | LARRY ALAN JOHNSON O.T.,C.H.T
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8421 E 61ST ST SUITE P
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City | TULSA
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State | OK
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Zip | 74133-1924
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Country | US
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Telephone | 918-459-9305
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Fax | 918-250-6032
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Provider Business Mailing Address
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Address Line | 8421 E 61ST ST SUITE P
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City | TULSA
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State | OK
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Zip | 74133-1924
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Country | US
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Telephone | 918-459-9305
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Fax | 918-250-6032
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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 | 003049
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License Number State | MO
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