Provider Demographics
NPI:1588815435
Name:JOHNSON, BETTIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BETTIE
Middle Name:
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 1:490 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2829
Mailing Address - Country:US
Mailing Address - Phone:215-884-6875
Mailing Address - Fax:
Practice Address - Street 1:1403 SHIRLEY LN
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2868
Practice Address - Country:US
Practice Address - Phone:888-558-0300
Practice Address - Fax:215-453-2076
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist