Basic Information
Provider Information
NPI: 1932538188
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: RHONDA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MOT, OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 170 PINECREST DR
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311347
CountryCode: US
TelephoneNumber: 7404467112
FaxNumber: 7404469088
Practice Location
Address1: 170 PINECREST DR
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311347
CountryCode: US
TelephoneNumber: 7404467112
FaxNumber: 7404469088
Other Information
ProviderEnumerationDate: 11/08/2013
LastUpdateDate: 11/08/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT.007771OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home