Provider Demographics
NPI:1053856807
Name:JOHNSON, JOELLE NAVONNE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:NAVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GLENWOOD AVE
Mailing Address - Street 2:#27J
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2164
Mailing Address - Country:US
Mailing Address - Phone:818-564-5049
Mailing Address - Fax:
Practice Address - Street 1:1 GLENWOOD AVE
Practice Address - Street 2:#27J
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2164
Practice Address - Country:US
Practice Address - Phone:818-564-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020857-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist