Provider Demographics
NPI:1083743462
Name:JOHNSON, MICHELLE MELITO (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MELITO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S PENTENWELL CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1788
Mailing Address - Country:US
Mailing Address - Phone:281-298-6404
Mailing Address - Fax:
Practice Address - Street 1:19073 INTERSTATE 45 S STE 145
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8744
Practice Address - Country:US
Practice Address - Phone:936-321-4700
Practice Address - Fax:936-321-4848
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111037225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2888OtherBCBS