Provider Demographics
NPI:1114347242
Name:JOHNSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 PIECK DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2692
Mailing Address - Country:US
Mailing Address - Phone:260-417-5042
Mailing Address - Fax:
Practice Address - Street 1:1987 PIECK DR
Practice Address - Street 2:UNIT B
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2692
Practice Address - Country:US
Practice Address - Phone:260-417-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist