Provider Demographics
NPI:1932413374
Name:JOHNSON, CONSTANCE P
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:PERSON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:6134 WAYNE AVENUE
Mailing Address - Street 2:APT. 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144
Mailing Address - Country:US
Mailing Address - Phone:267-625-4391
Mailing Address - Fax:
Practice Address - Street 1:6134 WAYNE AVE
Practice Address - Street 2:APT. 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-6110
Practice Address - Country:US
Practice Address - Phone:267-625-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001183L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist