Provider Demographics
NPI:1912589581
Name:JOHNSON, ABBY NICOLE (COTA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 W FRENCH PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5542
Mailing Address - Country:US
Mailing Address - Phone:062-825-7739
Mailing Address - Fax:
Practice Address - Street 1:15333 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:HILL COUNTRY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:78232-3719
Practice Address - Country:US
Practice Address - Phone:210-979-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216743224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant