Provider Demographics
NPI:1215218144
Name:JOHNSON-SIMCOX, JANICE (COTA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:JOHNSON-SIMCOX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1414 HALEY GRAY DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5730
Mailing Address - Country:US
Mailing Address - Phone:512-670-3491
Mailing Address - Fax:
Practice Address - Street 1:323 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3658
Practice Address - Country:US
Practice Address - Phone:512-762-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002898171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor