Provider Demographics
NPI:1376885145
Name:JOHNSON, STEPHANIE WHITAKER (MHS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:WHITAKER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:BIW 6045
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-2482
Mailing Address - Fax:706-721-8168
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BIW 6045
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2482
Practice Address - Fax:706-721-8168
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004750225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist