Provider Demographics
NPI:1083363964
Name:JOHNSON, DONOVAN ANTHONY (OTR/L CNS)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OTR/L CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4661 DANA DR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1610
Mailing Address - Country:US
Mailing Address - Phone:562-688-2065
Mailing Address - Fax:
Practice Address - Street 1:10625 LEFFINGWELL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3434
Practice Address - Country:US
Practice Address - Phone:562-864-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21462225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist