Provider Demographics
NPI:1871981597
Name:JOHNSON, CARLOTTA ELAINE (MOTR/L)
Entity type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:ELAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:301 NORTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:SINCLAIR
Mailing Address - State:WY
Mailing Address - Zip Code:82334
Mailing Address - Country:US
Mailing Address - Phone:307-258-3655
Mailing Address - Fax:
Practice Address - Street 1:301 NORTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:SINCLAIR
Practice Address - State:WY
Practice Address - Zip Code:82334
Practice Address - Country:US
Practice Address - Phone:307-258-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-760225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist