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NPI Code Detail

MEDICARE: DALE D JOHNSON OTR

MEDICARE: DALE D JOHNSON OTR
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
1225X00000XOccupational Therapist1702536KS

General Provider Information

NPI Number : 1366677890
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALE D JOHNSON OTR
Provider Business Mailing Address
First Line : 2382 GRAND RD
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-1888
Country : US
Telephone Number : 615-896-6400
Fax Number :
Provider Business Practice Location Address
First Line : 915 HORTON ST
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-2437
Country : US
Telephone Number : 615-896-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2009
Last Update Date : 05/28/2009

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Directions to “ DALE D JOHNSON OTR” Practice Location

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