Provider Demographics
NPI:1801665377
Name:JOHNSON, ALYSE RING (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:RING
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:MAIRE
Other - Last Name:RING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2418 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4422
Mailing Address - Country:US
Mailing Address - Phone:336-534-0210
Mailing Address - Fax:
Practice Address - Street 1:1 MARITHE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2702
Practice Address - Country:US
Practice Address - Phone:336-852-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist