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General NPI Number Information
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NPI Number | 1699318519
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Entity Type | Individual
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Provider Name | ANDREW W JOHNSON O.T.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 1351 FOWLER ST
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City | RICHLAND
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State | WA
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Zip | 99352-4714
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Country | US
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Telephone | 509-946-1654
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Fax | 509-943-5652
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Provider Business Mailing Address
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Address Line | 550 GAGE BLVD STE 101
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City | RICHLAND
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State | WA
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Zip | 99352-9532
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Country | US
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Telephone | 509-946-1654
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Fax | 509-943-5652
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT61006513
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License Number State | WA
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