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Individual

MRS. LISA DIANE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
1030 JEFFERSON AVE, 117 OT, MEMPHIS, TN 38104-2127
(901) 523-8990
(901) 577-7459
Mailing address
61 LOCHMEADE DR, ATOKA, TN 38004-7870
(901) 837-2557

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0000000032
TN

Other

Enumeration date
07/18/2006
Last updated
07/08/2007
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