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General NPI Number Information
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NPI Number | 1326063033
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Entity Type | Individual
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Provider Name | RETTA PASCHAL JOHNSON OTR/L, CHT
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4901 DEERFOOT PKWY STE 200
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2697
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Country | US
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Telephone | 205-960-9995
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Fax | 205-661-9841
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Provider Business Mailing Address
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Address Line | PO BOX 723
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City | TRUSSVILLE
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State | AL
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Zip | 35173-0723
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Country | US
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Telephone | 205-960-9995
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Fax | 205-661-9841
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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 | 0289
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License Number State | AL
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