Individual
BRADY NICHOLAS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTD, OTR/L
Contact information
Practice address
6773 DESERT STORM AVE BLDG 6749, FORT CAMPBELL, KY 42223-5504
(563) 940-5173
Mailing address
2934 DUNLOP LN APT 312, CLARKSVILLE, TN 37043-1455
(563) 940-5173
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2436
HI
Other
Enumeration date
02/06/2024
Last updated
02/06/2024
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