Provider Demographics
NPI:1275201519
Name:JOHNSON, HANNAH NOELLE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NOELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 N FM 620 RD APT 2237
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-3566
Mailing Address - Country:US
Mailing Address - Phone:757-493-1123
Mailing Address - Fax:
Practice Address - Street 1:302 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5632
Practice Address - Country:US
Practice Address - Phone:512-501-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist