Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1498 PORT MALABAR BLVD NE, PALM BAY, FL 32905-5240
(321) 848-7349
Mailing address
1498 PORT MALABAR BLVD NE, PALM BAY, FL 32905-5240
(321) 848-7349
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009365
NY
224Z00000X
Occupational Therapy Assistant
OTA15677
FL
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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