Provider Demographics
NPI:1447559661
Name:JOHNSON, NAOMI AYETIN (COTA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:AYETIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 GRAND PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4165
Mailing Address - Country:US
Mailing Address - Phone:832-229-7018
Mailing Address - Fax:
Practice Address - Street 1:1212 GRAND PLAZA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4165
Practice Address - Country:US
Practice Address - Phone:832-229-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210771224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24636339OtherTEXAS DRIVERS LIC