Provider Demographics
NPI:1699318519
Name:JOHNSON, ANDREW W (OT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-946-1654
Mailing Address - Fax:509-943-5652
Practice Address - Street 1:1351 FOWLER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4714
Practice Address - Country:US
Practice Address - Phone:509-946-1654
Practice Address - Fax:509-943-5652
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
WAOT61006513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist