Provider Demographics
NPI:1073694022
Name:JOHNSON, CARYL D (OT CHT)
Entity Type:Individual
Prefix:MRS
First Name:CARYL
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 237046
Mailing Address - Street 2:ANSONIA STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-0028
Mailing Address - Country:US
Mailing Address - Phone:212-721-0460
Mailing Address - Fax:646-559-2792
Practice Address - Street 1:160 W 66TH ST
Practice Address - Street 2:SUITE 37-J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6555
Practice Address - Country:US
Practice Address - Phone:212-721-0460
Practice Address - Fax:646-559-2792
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P391770OtherOXFORD
NYQ5962Q5061OtherMEDICARE