Basic Information
| Provider Information | |||||||||
| NPI: | 1164958385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1732 1/2 EUCLID ST NW | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200092810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078313566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 1ST ST NE FL 9 | ||||||||
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| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200027953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024425885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2017 | ||||||||
| LastUpdateDate: | 08/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.