Provider Demographics
NPI:1033494364
Name:JOHNSON, AMBER MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
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 1:2277 STEVENS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:KY
Mailing Address - Zip Code:41007-8522
Mailing Address - Country:US
Mailing Address - Phone:859-992-9572
Mailing Address - Fax:
Practice Address - Street 1:3876 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018-2838
Practice Address - Country:US
Practice Address - Phone:859-342-8775
Practice Address - Fax:859-342-8701
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA4808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant