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NPI Code Detail

MEDICARE: MRS. NANCY ELIZABETH JOHNSON OT

MEDICARE: MRS. NANCY ELIZABETH JOHNSON OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist1862NC

General Provider Information

NPI Number : 1033260336
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NANCY ELIZABETH JOHNSON OT
Provider Business Mailing Address
First Line : 2620 BAYTREE DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-1154
Country : US
Telephone Number : 336-545-3010
Fax Number :
Provider Business Practice Location Address
First Line : 2300 SPRING GARDEN ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-2135
Country : US
Telephone Number : 336-294-3338
Fax Number : 336-294-6696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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