Provider Demographics
NPI:1891275558
Name:JOHNSON, ALVIN RAY JR (OTA)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:RAY
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5110
Mailing Address - Country:US
Mailing Address - Phone:214-433-9421
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-5110
Practice Address - Country:US
Practice Address - Phone:214-433-9421
Practice Address - Fax:214-433-9421
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212947224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant