Provider Demographics
NPI:1588411250
Name:SALAS, JOHANN LEACH (OTR)
Entity type:Individual
Prefix:
First Name:JOHANN
Middle Name:LEACH
Last Name:SALAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 TEXAS BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6889
Mailing Address - Country:US
Mailing Address - Phone:817-793-7105
Mailing Address - Fax:
Practice Address - Street 1:20424 HAYSTACK CV
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF
Practice Address - State:TX
Practice Address - Zip Code:78669-6441
Practice Address - Country:US
Practice Address - Phone:512-261-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist