Provider Demographics
NPI:1073982054
Name:SNO, JOHANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:SNO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 THIMBLEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4379
Mailing Address - Country:US
Mailing Address - Phone:518-312-5528
Mailing Address - Fax:
Practice Address - Street 1:171 THIMBLEBERRY RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4379
Practice Address - Country:US
Practice Address - Phone:518-312-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019562-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist