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NPI Code Detail

MEDICARE: TIFFANY MONIQUE JOHNSON OTR, MOT

MEDICARE: TIFFANY MONIQUE JOHNSON OTR, MOT
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 Therapist113794TX

General Provider Information

NPI Number : 1568752301
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY MONIQUE JOHNSON OTR, MOT
Provider Business Mailing Address
First Line : 411 N WASHINGTON AVE STE 4000
Second Line :
City : DALLAS
State : TX
Zip : 75246-1776
Country : US
Telephone Number : 214-820-9393
Fax Number : 214-820-8877
Provider Business Practice Location Address
First Line : 411 N WASHINGTON AVE STE 4000
Second Line :
City : DALLAS
State : TX
Zip : 75246-1776
Country : US
Telephone Number : 214-820-9393
Fax Number : 214-820-8877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2011
Last Update Date : 04/13/2011

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