Individual
TYLER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1715 NORTHFIELD DR, ROCHESTER HILLS, MI 48309-3819
(248) 293-2400
Mailing address
46401 JONATHAN CIR APT 104, SHELBY TOWNSHIP, MI 48317-3864
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13225
OCCUPATIONAL THERAPIST LICENSE
CA
01
—
5201009026
OCCUPATIONAL THERAPIST LICENSE
MI
Enumeration date
12/20/2018
Last updated
12/20/2018
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