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NPI Code Detail

MEDICARE: MR. TIMOTHY JOE JOHNSON OTR

MEDICARE:  MR. TIMOTHY JOE 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 Therapist31003116AIN

General Provider Information

NPI Number : 1841500865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY JOE JOHNSON OTR
Provider Business Mailing Address
First Line : 3461 SAINT MARYS RD
Second Line :
City : WEST TERRE HAUTE
State : IN
Zip : 47885-9683
Country : US
Telephone Number : 812-917-5618
Fax Number : 812-917-5618
Provider Business Practice Location Address
First Line : 3461 SAINT MARYS RD
Second Line :
City : WEST TERRE HAUTE
State : IN
Zip : 47885-9683
Country : US
Telephone Number : 812-917-5618
Fax Number : 812-917-5618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2010
Last Update Date : 10/08/2010

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Directions to “ MR. TIMOTHY JOE JOHNSON OTR” Practice Location

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