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General NPI Number Information
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NPI Number | 1336276260
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Entity Type | Individual
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Provider Name | JUDITH JOHNSON OT
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2000 E EDGEWOOD DR SUITE 114
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City | LAKELAND
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State | FL
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Zip | 33803-3653
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Country | US
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Telephone | 863-577-1981
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Fax | 863-577-1983
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Provider Business Mailing Address
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Address Line | PO BOX 1838
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City | LAKELAND
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State | FL
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Zip | 33802-1838
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Country | US
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Telephone | 863-687-0931
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Fax | 863-687-4021
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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 | OT146
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License Number State | FL
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