Individual
MRS. CAROL RENEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
711 AVIGNON DR, RIDGELAND, MS 39157-5120
(601) 605-6777
(601) 605-8869
Mailing address
225 BRADFORD PL, RICHLAND, MS 39218-9690
(601) 665-4791
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA1918
MS
Other
Enumeration date
01/29/2007
Last updated
04/14/2008
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