Provider Demographics
NPI:1124199898
Name:JOHNSON, MELISSA J (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 N ASH ST
Mailing Address - Street 2:APT. #816
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-2767
Mailing Address - Country:US
Mailing Address - Phone:810-599-3150
Mailing Address - Fax:
Practice Address - Street 1:4001 E BASELINE RD
Practice Address - Street 2:STE B2
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2726
Practice Address - Country:US
Practice Address - Phone:480-539-5629
Practice Address - Fax:480-539-5669
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 006597225X00000X, 225XE1200X, 225XH1300X, 225XN1300X, 225XP0200X
AZ3865225X00000X, 225XP0200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation