Individual
LACANDICE NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637
(813) 978-9700
(813) 558-6186
Mailing address
13020 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0925
(813) 978-9700
(813) 558-6186
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT19435
FL
225X00000X
Occupational Therapist
OTR3110
AR
Other
Enumeration date
12/04/2017
Last updated
01/28/2020
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