Provider Demographics
NPI:1326775115
Name:JOHNSON, DENISE NICOLE (MOT)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:219 AVON RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2327
Mailing Address - Country:US
Mailing Address - Phone:407-284-8044
Mailing Address - Fax:
Practice Address - Street 1:11832 ROCK LANDING DR STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4261
Practice Address - Country:US
Practice Address - Phone:757-455-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics