Provider Demographics
NPI:1326286881
Name:JOHNSON, SHIRLEY M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:M
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 1:1689 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-6127
Mailing Address - Country:US
Mailing Address - Phone:440-861-2691
Mailing Address - Fax:
Practice Address - Street 1:1689 POPLAR LN
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-6127
Practice Address - Country:US
Practice Address - Phone:440-861-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003821174400000X, 282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No174400000XOther Service ProvidersSpecialist