Provider Demographics
NPI:1083734321
Name:JOHNSON, DAVID L (OT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3899 NW 7TH ST
Mailing Address - Street 2:STE 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5551
Mailing Address - Country:US
Mailing Address - Phone:305-644-4181
Mailing Address - Fax:
Practice Address - Street 1:2241B N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-961-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7865AOtherMEDICARE LEGACY
FLE7865AOtherMEDICARE LEGACY
FLE7865AMedicare PIN