Provider Demographics
NPI:1992091227
Name:JOHNSON, JUDITH IRENE (LOT, CHT)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:IRENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LOT, CHT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:I
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LOT, CHT
Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:210-297-2725
Mailing Address - Fax:210-297-0215
Practice Address - Street 1:8711 VILLAGE DR
Practice Address - Street 2:109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5418
Practice Address - Country:US
Practice Address - Phone:210-297-2725
Practice Address - Fax:210-297-0215
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100944225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand