Provider Demographics
NPI:1861559809
Name:JOHNSON, MARIE A (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:SZWED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:175 BURROUGHS DR
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3968
Mailing Address - Country:US
Mailing Address - Phone:716-839-4760
Mailing Address - Fax:
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-3145
Practice Address - Fax:716-898-3259
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist