Provider Demographics
NPI:1396247920
Name:JOHNSON, TALIA SHAKIRA (MSOT,OTRL)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:SHAKIRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSOT,OTRL
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-0500
Mailing Address - Country:US
Mailing Address - Phone:516-984-2011
Mailing Address - Fax:
Practice Address - Street 1:1718 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2552
Practice Address - Country:US
Practice Address - Phone:443-200-5294
Practice Address - Fax:443-348-5970
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation