Individual
MRS. DIANE RENEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1414 S DENVER AVE, TULSA, OK 74119-3423
(918) 712-7805
Mailing address
PO BOX 577, BARNSDALL, OK 74002-0577
(918) 639-3212
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
493
OK
Other
Enumeration date
06/15/2012
Last updated
06/15/2012
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