MEDICARE: TAKARA JOHNSON

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	347C00000X	Private Vehicle
2	374U00000X	Home Health Aide
3	225700000X	Massage Therapist	7501015577	MI

General Provider Information

NPI Number	:	1225980287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKARA JOHNSON

Provider Business Mailing Address
First Line	:	21999 FARMINGTON RD
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-4400
Country	:	US
Telephone Number	:	248-826-9258
Fax Number	:

Provider Business Practice Location Address
First Line	:	21999 FARMINGTON RD
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48336-4400
Country	:	US
Telephone Number	:	248-826-9258
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ TAKARA JOHNSON ” Practice Location

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