Provider Demographics
NPI:1427528223
Name:JOHNSON, TAMBRA M (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TAMBRA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TAMBRA.JOHNSON@PGCPS.ORG
Practice Address - Street 2:2300 BELLEVIEW AVE, CHEVERLY, MD 20785
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:240-535-2720
Practice Address - Fax:301-925-1985
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist