Individual
TRACI LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
101 N PLAIN RD, JACKSONVILLE, NC 28546-6760
(910) 502-9338
Mailing address
101 N PLAIN RD, JACKSONVILLE, NC 28546-6760
(910) 502-9338
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
16301
NC
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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