=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326775115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE NICOLE JOHNSON MOT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1030 LOFTIS BLVD STE 103
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-2999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-720-0099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX #3
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-284-8044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 0119009648
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------