Provider Demographics
NPI:1619144813
Name:JOHNSON, HEATHER ELIZABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:9898 SCOTTISH GLEN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3854
Mailing Address - Country:US
Mailing Address - Phone:702-241-5568
Mailing Address - Fax:877-214-5160
Practice Address - Street 1:9898 SCOTTISH GLEN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178
Practice Address - Country:US
Practice Address - Phone:702-241-5568
Practice Address - Fax:877-214-5160
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6577225X00000X
AZ5961225X00000X
NV15-0598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist