Provider Demographics
NPI:1801014352
Name:JOHNSON, NATHANIEL C (MS OTR L)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3116
Mailing Address - Country:US
Mailing Address - Phone:908-303-4092
Mailing Address - Fax:
Practice Address - Street 1:37 ORIOLE DR
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3116
Practice Address - Country:US
Practice Address - Phone:908-303-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00391800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist