Provider Demographics
NPI:1154542223
Name:JOHNSON, CAROL L (OTRL)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 NELSON HWY STE H
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7883
Mailing Address - Country:US
Mailing Address - Phone:919-493-1170
Mailing Address - Fax:919-493-1640
Practice Address - Street 1:2226 NELSON HWY STE H
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7883
Practice Address - Country:US
Practice Address - Phone:919-493-1170
Practice Address - Fax:919-493-1640
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0602225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0443MOtherBCBS NC DME
NC12411OtherBLUE CROSS BLUE SHIELD NC
NC5621622071OtherTRICARE
NC0443MOtherBCBS NC DME
NC5621622071OtherTRICARE