Individual
STEPHANIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
242 CHURCH ST., CLAY, WV 25043
(304) 587-2713
Mailing address
5171 IRISH HEIGHTS DR, SUMMERSVILLE, WV 26651-1921
(304) 872-9450
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1243
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003839
—
WV
Enumeration date
10/05/2006
Last updated
07/08/2007
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