Provider Demographics
NPI:1639443898
Name:JOHNSON, TOMI LEIGH (MOTR, LMP)
Entity Type:Individual
Prefix:MS
First Name:TOMI
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MOTR, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23425 SE 250TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7941
Mailing Address - Country:US
Mailing Address - Phone:425-679-2727
Mailing Address - Fax:
Practice Address - Street 1:17700 SE 272ND ST STE 110
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-372-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013993225700000X
WAOT60276076225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist