Provider Demographics
NPI:1225187453
Name:JOHNSON, BECCA D (OT)
Entity Type:Individual
Prefix:
First Name:BECCA
Middle Name:D
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 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:11930 HERITAGE OAK PL
Practice Address - Street 2:# 9
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2458
Practice Address - Country:US
Practice Address - Phone:530-887-8785
Practice Address - Fax:530-887-8112
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5176225X00000X
1031100122225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT846AMedicare PIN