Provider Demographics
NPI:1346535069
Name:JOHNSON, ASHLEY MARIE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
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 1:9823 COLONIAL WALK S
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6309
Mailing Address - Country:US
Mailing Address - Phone:239-250-3047
Mailing Address - Fax:
Practice Address - Street 1:2330 IMMOKALEE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1414
Practice Address - Country:US
Practice Address - Phone:239-596-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14277225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics