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General NPI Number Information
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NPI Number | 1205442183
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Entity Type | Individual
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Provider Name | BRIANNE JOHNSON OTR
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Gender | Female
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 2180 N MAIN ST
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City | BELTON
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State | TX
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Zip | 76513-1919
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Country | US
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Telephone | 254-773-6787
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Fax |
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Provider Business Mailing Address
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Address Line | 912 WYNDCREST DR
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City | TEMPLE
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State | TX
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Zip | 76502-2076
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Country | US
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Telephone | 540-532-0688
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 119550
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License Number State | TX
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