Individual
JEREMY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
3414 CURTIS DR, SUITLAND, MD 20746-4935
(202) 271-2395
Mailing address
3414 CURTIS DR, SUITLAND, MD 20746-4935
(202) 271-2395
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
59263
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851874051
—
MD
01
—
83-1623156
MARYLAND
MD
Enumeration date
09/14/2018
Last updated
09/14/2018
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