Individual
MRS. DORA DIANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9340 RUBY RD, HOLLY, MI 48442-9305
(810) 694-0290
Mailing address
9340 RUBY RD, HOLLY, MI 48442-9305
(810) 694-0290
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202006804
MI
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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