Provider Demographics
NPI:1649207499
Name:JOHNSON, CAROL LEIGH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LEIGH
Last Name:JOHNSON
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 1:11913 SAWHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-3647
Mailing Address - Country:US
Mailing Address - Phone:540-785-2484
Mailing Address - Fax:
Practice Address - Street 1:2800 WELLFORD ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3176
Practice Address - Country:US
Practice Address - Phone:540-373-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist