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General NPI Number Information
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NPI Number | 1841439601
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Entity Type | Individual
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Provider Name | WILLIAM MICHAEL JOHNSON OTR
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Gender | Male
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 12425 RACE TRACK RD SUITE 100
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City | TAMPA
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State | FL
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Zip | 33626-3102
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Country | US
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Telephone | 866-416-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 3202 OTTOGAN ST
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9647
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Country | US
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Telephone | 616-250-0990
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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 | 5201007497
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License Number State | MI
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