Provider Demographics
NPI:1568223345
Name:JOHNSON, CYDNE CAROLINE (OTR)
Entity Type:Individual
Prefix:
First Name:CYDNE
Middle Name:CAROLINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N 11TH ST APT 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4373
Mailing Address - Country:US
Mailing Address - Phone:517-231-4801
Mailing Address - Fax:
Practice Address - Street 1:100 DELMAR GARDENS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-3216
Practice Address - Country:US
Practice Address - Phone:702-361-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist