Provider Demographics
NPI:1699799478
Name:JOHNSON, CHRISTOPHER RUSSELL (OTR/L, MS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RUSSELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 33100
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-3100
Mailing Address - Country:US
Mailing Address - Phone:314-636-9792
Mailing Address - Fax:
Practice Address - Street 1:319 SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:NEWMANSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17073-8943
Practice Address - Country:US
Practice Address - Phone:717-507-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12526225X00000X
PAOC007114L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist