Provider Demographics
NPI:1427337344
Name:JOHNSON, CAROL MARSH
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARSH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 CROWN ST
Mailing Address - Street 2:APT # 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5864
Mailing Address - Country:US
Mailing Address - Phone:516-607-3061
Mailing Address - Fax:
Practice Address - Street 1:795 CROWN ST
Practice Address - Street 2:APT # 2F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5864
Practice Address - Country:US
Practice Address - Phone:516-607-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist