Provider Demographics
NPI:1174275101
Name:JOHNSON, NOEL LYNN
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:LYNN
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 1:1106 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9754
Mailing Address - Country:US
Mailing Address - Phone:717-917-4498
Mailing Address - Fax:
Practice Address - Street 1:1200 TEL HAI CIR
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-1271
Practice Address - Country:US
Practice Address - Phone:610-273-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010168224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty