Provider Demographics
NPI:1093860967
Name:JOHNSON, LARRY ALAN (OT,CHT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 E 61ST ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1924
Mailing Address - Country:US
Mailing Address - Phone:918-459-9305
Mailing Address - Fax:918-250-6032
Practice Address - Street 1:8421 E 61ST ST
Practice Address - Street 2:SUITE P
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1924
Practice Address - Country:US
Practice Address - Phone:918-459-9305
Practice Address - Fax:918-250-6032
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003049225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand