Provider Demographics
NPI:1073995387
Name:JOHNSON-SMITH, BROOKE DANETTE (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:DANETTE
Last Name:JOHNSON-SMITH
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 1:106 CALLOWAY CT
Mailing Address - Street 2:APT. 202
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8440
Mailing Address - Country:US
Mailing Address - Phone:828-719-9238
Mailing Address - Fax:
Practice Address - Street 1:106 CALLOWAY CT
Practice Address - Street 2:APT. 202
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8440
Practice Address - Country:US
Practice Address - Phone:828-719-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8178225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist