Provider Demographics
NPI:1548305501
Name:JOHNSON, NORMA JEAN (BOC ABC)
Entity type:Individual
Prefix:
First Name:NORMA JEAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BOC ABC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LAKE DR.
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1359
Mailing Address - Country:US
Mailing Address - Phone:731-623-4333
Mailing Address - Fax:731-623-4333
Practice Address - Street 1:140 LAKE DR.
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079-1359
Practice Address - Country:US
Practice Address - Phone:731-623-4333
Practice Address - Fax:731-623-4333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter