Provider Demographics
NPI:1043355472
Name:JOHNSON, JANICE E (OT)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4142
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-4142
Mailing Address - Country:US
Mailing Address - Phone:928-443-1870
Mailing Address - Fax:928-443-1870
Practice Address - Street 1:HUMBOLDT UNIFIED SCHOOL DISTRICT #22 SPECIAL SRVCS OFIC
Practice Address - Street 2:8766 EAST HWY 69
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-859-4028
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458994Medicaid