Provider Demographics
NPI:1144460965
Name:JOHNSON, MARTHA DEAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:DEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ELK MOUNTAIN SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1706
Mailing Address - Country:US
Mailing Address - Phone:828-253-6555
Mailing Address - Fax:
Practice Address - Street 1:160 ELK MOUNTAIN SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1706
Practice Address - Country:US
Practice Address - Phone:828-253-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003914225XP0200X
NC8545225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics