Individual
MRS. BRENNA STANLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
817 N MOUND ST, NACOGDOCHES, TX 75961
(936) 564-6907
(936) 564-0509
Mailing address
817 N MOUND ST, NACOGDOCHES, TX 75961-4427
(936) 564-6907
(936) 564-0509
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
107063
TX
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
107063
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1637803-01
—
TX
05
—
1637803-02
—
TX
01
—
659657
BCBS #
TX
Enumeration date
08/04/2006
Last updated
02/16/2023
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