Provider Demographics
NPI:1821420613
Name:JOHNSON, TOSUCHA JAY (OTR)
Entity Type:Individual
Prefix:MS
First Name:TOSUCHA
Middle Name:JAY
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 1:12360 RIVERSIDE DR
Mailing Address - Street 2:311
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3644
Mailing Address - Country:US
Mailing Address - Phone:323-252-1605
Mailing Address - Fax:
Practice Address - Street 1:12360 RIVERSIDE DR
Practice Address - Street 2:#311
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3644
Practice Address - Country:US
Practice Address - Phone:323-252-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist