Provider Demographics
NPI:1164709598
Name:JOHNSON, WHITNEY ANNE (OT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WAURIKA
Mailing Address - State:OK
Mailing Address - Zip Code:73573-3008
Mailing Address - Country:US
Mailing Address - Phone:918-906-5370
Mailing Address - Fax:
Practice Address - Street 1:107 E ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573-3008
Practice Address - Country:US
Practice Address - Phone:918-906-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144442083X0100X
OK1673225XP0200X, 225XP0019X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation