Provider Demographics
NPI:1295966067
Name:HOUSTON, AMY JOHNSON (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JOHNSON
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 EAST HARBOR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3555
Mailing Address - Country:US
Mailing Address - Phone:615-826-9857
Mailing Address - Fax:
Practice Address - Street 1:139 MAPLE ROW BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3853
Practice Address - Country:US
Practice Address - Phone:615-826-7113
Practice Address - Fax:615-826-7139
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000915225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4249773OtherBLUE CROSS BLUE SHIELD
TN1514573Medicaid