Individual
MRS. TAMARA IRENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
422 23RD ST, OAK HILL, WV 25901-2830
(304) 465-1903
Mailing address
RR 2 BOX 246 H, TREADWAY RD., FAYETTEVILLE, WV 25840
(304) 465-1903
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1486
WV
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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