Provider Demographics
NPI:1356691521
Name:JOHNSON, WHITNEY DOUGLAS (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DOUGLAS
Last Name:JOHNSON
Suffix:
Gender:F
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 1:22149 RT 122
Mailing Address - Street 2:
Mailing Address - City:MELVIN
Mailing Address - State:KY
Mailing Address - Zip Code:41650
Mailing Address - Country:US
Mailing Address - Phone:859-779-8092
Mailing Address - Fax:
Practice Address - Street 1:26901 US HIGHWAY 119 SOUTH
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514
Practice Address - Country:US
Practice Address - Phone:606-237-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist