Provider Demographics
NPI:1225377351
Name:JOHNSON, HOLLY ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SKYLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3727
Mailing Address - Country:US
Mailing Address - Phone:321-720-6667
Mailing Address - Fax:
Practice Address - Street 1:470 SKYLARK BLVD
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3727
Practice Address - Country:US
Practice Address - Phone:321-720-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT2116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist