Provider Demographics
NPI:1033318159
Name:JOHNSON, DONALD JEFFREY (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JEFFREY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ACADIA DR
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-4306
Mailing Address - Country:US
Mailing Address - Phone:410-688-9805
Mailing Address - Fax:
Practice Address - Street 1:13801 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1825
Practice Address - Country:US
Practice Address - Phone:410-688-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01140224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant