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General NPI Number Information
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NPI Number | 1598018103
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Entity Type | Individual
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Provider Name | LISA MARIE JOHNSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 9555 RIBAUT ROAD BEAUFORT MEMORIAL HOSPITAL
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City | BEAUFORT
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State | SC
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Zip | 29902
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Country | US
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Telephone | 843-522-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 PRESERVE AVE W APT 2238
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City | PORT ROYAL
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State | SC
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Zip | 29935-2527
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Country | US
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Telephone | 843-450-6480
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4024
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 4024
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License Number State | SC
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