Provider Demographics
NPI:1629841812
Name:JOHNSON, CEIANNA NICHOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CEIANNA
Middle Name:NICHOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CEIANNA
Other - Middle Name:NICHOLE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:304-917-3660
Mailing Address - Fax:304-917-3674
Practice Address - Street 1:2010 GARFIELD AVE STE 2
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2529
Practice Address - Country:US
Practice Address - Phone:304-917-3649
Practice Address - Fax:304-917-3651
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007597224Z00000X
WVC2333224Z00000X
OHOT012725225X00000X
WV2421225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant