Organization
JOHNSON'S FUNCTIONAL VILLAGE, LLC
Active
Other names
Johnson's Functional Village, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATTIA-NYDE CHAMPAGNE JOHNSON OTR/L (OCCUPATIONAL THERAPIST)
(256) 299-5380
Entity
Organization
Contact information
Practice address
8000 MADISON BLVD STE D102-208, MADISON, AL 35758-2031
(256) 299-5380
(256) 464-3045
Mailing address
8000 MADISON BLVD STE D102-208, MADISON, AL 35758-2031
(256) 299-5380
(256) 464-3045
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225481781
—
AL
Enumeration date
04/07/2021
Last updated
04/07/2021
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