Provider Demographics
NPI:1013156009
Name:JOHNSON, CASEY (MS OTRL)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WAKE FOREST RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7340
Mailing Address - Country:US
Mailing Address - Phone:919-872-3171
Mailing Address - Fax:919-872-6739
Practice Address - Street 1:3404 WAKE FOREST RD
Practice Address - Street 2:SUITE 303
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7340
Practice Address - Country:US
Practice Address - Phone:919-872-3171
Practice Address - Fax:919-872-6739
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6319225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand