Provider Demographics
NPI:1508263484
Name:JOHNSON, AMANDA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
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 1:1701 S 2650 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3250
Mailing Address - Country:US
Mailing Address - Phone:801-597-1340
Mailing Address - Fax:801-731-0910
Practice Address - Street 1:2317 N HILL FIELD RD
Practice Address - Street 2:#103
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4781
Practice Address - Country:US
Practice Address - Phone:801-597-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50740384201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist