Provider Demographics
NPI:1811884224
Name:JOHNSON, DERIYON SHENIQUE (OTD, OTR)
Entity type:Individual
Prefix:
First Name:DERIYON
Middle Name:SHENIQUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 HILL ST APT 4117
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5177
Mailing Address - Country:US
Mailing Address - Phone:678-360-9511
Mailing Address - Fax:
Practice Address - Street 1:1881 SYLVAN AVE STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2002
Practice Address - Country:US
Practice Address - Phone:214-333-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist