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General NPI Number Information
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NPI Number | 1871981654
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Entity Type | Individual
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Provider Name | CHRISTINE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 412 N DALTON ST
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City | BARTLETT
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State | TX
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Zip | 76511-4332
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Country | US
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Telephone | 254-527-3371
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 WOODLAWN ST
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City | TAYLOR
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State | TX
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Zip | 76574-5042
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Country | US
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Telephone | 512-439-9243
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 206652
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License Number State | TX
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