Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6901 N CHARLES ST, TOWSON, MD 21204-3780
(410) 284-8050
Mailing address
613 GOODMAN AVE, DUNDALK, MD 21222-1319
(410) 284-8050
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
04856
MD
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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