Provider Demographics
NPI:1518232156
Name:JOHNSON, AMBER N (COTA/ L)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA/ L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30528 LIPIZZAN TER
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7837
Mailing Address - Country:US
Mailing Address - Phone:850-459-1180
Mailing Address - Fax:
Practice Address - Street 1:30528 LIPIZZAN TER
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7837
Practice Address - Country:US
Practice Address - Phone:850-459-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 12197224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant