MEDICARE: MS. SUSAN MICHELLE 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
1	225X00000X	Occupational Therapist	104504	TX

General Provider Information

NPI Number	:	1043351257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MICHELLE JOHNSON OT

Provider Business Mailing Address
First Line	:	309 DEER RIDGE DR
Second Line	:
City	:	GATESVILLE
State	:	TX
Zip	:	76528-3369
Country	:	US
Telephone Number	:	940-923-3415
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 MEDICAL CENTER RD
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-553-3250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	05/27/2026

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