Individual
DIANE KAREN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
175 SUNCREST RD, TALENT, OR 97540-8686
(541) 535-7772
Mailing address
175 SUNCREST RD, TALENT, OR 97540-8686
(541) 535-7772
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
914267
OR
225X00000X
Occupational Therapist
OT 00001834
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119003
—
OR
Enumeration date
06/20/2008
Last updated
06/20/2008
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