Individual
SHABREVIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10631 S 51ST ST, SUITE 8, PHOENIX, AZ 85044-5225
(480) 398-4280
(480) 398-4281
Mailing address
PO BOX 50218, PHOENIX, AZ 85076-0218
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5276
AZ
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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