Provider Demographics
NPI:1528606696
Name:JOHNSON, DEANNA JEAN (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:JEAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:23 KINGSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-2102
Mailing Address - Country:US
Mailing Address - Phone:570-637-2460
Mailing Address - Fax:
Practice Address - Street 1:15900 US-6
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009798224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant