MEDICARE: AMY 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	224Z00000X	Occupational Therapy Assistant	OTA11493	FL

General Provider Information

NPI Number	:	1295235224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JOHNSON

Provider Business Mailing Address
First Line	:	4615 TROUT RIVER XING
Second Line	:
City	:	ELLENTON
State	:	FL
Zip	:	34222-7287
Country	:	US
Telephone Number	:	508-713-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 ASTON GARDENS CT
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-3824
Country	:	US
Telephone Number	:	813-642-3424
Fax Number	:

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

Provider Enumeration Date	:	02/16/2018
Last Update Date	:	02/16/2018

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