Provider Demographics
NPI:1114194180
Name:JOHNSON, BRANDON M (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 WOODINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-0024
Mailing Address - Country:US
Mailing Address - Phone:919-524-5049
Mailing Address - Fax:704-732-4676
Practice Address - Street 1:935 WOODINGTON LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-0024
Practice Address - Country:US
Practice Address - Phone:919-524-5049
Practice Address - Fax:704-732-4676
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist