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General NPI Number Information
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NPI Number | 1811884224
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Entity Type | Individual
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Provider Name | DERIYON SHENIQUE JOHNSON OTD, OTR
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1881 SYLVAN AVE STE 150
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City | DALLAS
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State | TX
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Zip | 75208-2002
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Country | US
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Telephone | 214-333-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 HILL ST APT 4117
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-5177
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Country | US
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Telephone | 678-360-9511
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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 | 125539
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License Number State | TX
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