Individual
SHANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
18480 W PORT ROYALE LN, SURPRISE, AZ 85388-7678
(623) 776-5626
Mailing address
18480 W PORT ROYALE LN, SURPRISE, AZ 85388-7678
(623) 776-5626
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2743
AZ
Other
Enumeration date
06/15/2016
Last updated
06/15/2016
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