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NPI Code Detail

MEDICARE: NICOLE LEIGH JOHNSON OTR/L

MEDICARE: NICOLE LEIGH JOHNSON OTR/L
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 Therapist0119005295VA
2225X00000XOccupational TherapistOT010000656DC

General Provider Information

NPI Number : 1609168186
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LEIGH JOHNSON OTR/L
Provider Business Mailing Address
First Line : 2721 S ADAMS ST
Second Line : APT. 206
City : ARLINGTON
State : VA
Zip : 22206-2878
Country : US
Telephone Number : 908-392-4076
Fax Number :
Provider Business Practice Location Address
First Line : 5000 NANNIE HELEN BURROUGHS AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-5506
Country : US
Telephone Number : 908-392-4076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2011
Last Update Date : 05/03/2011

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Directions to “ NICOLE LEIGH JOHNSON OTR/L” Practice Location

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