MEDICARE: THERESA F JOHNSON OT

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	225X00000X	Occupational Therapist	01170	IA

General Provider Information

NPI Number	:	1619066552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA F JOHNSON OT

Provider Business Mailing Address
First Line	:	4319 NW URBANDALE DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-7910
Country	:	US
Telephone Number	:	515-225-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 NW URBANDALE DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-7910
Country	:	US
Telephone Number	:	515-225-4070
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	11/02/2022

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