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1548610041
SHANE JOHNSON
SURPRISE, AZ
NPI
1548610041
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: AZ 2743)
Enumeration Date
2016-06-15
Last Update Date
2016-06-15
Business Address
SHANE JOHNSON OTR/L
18480 W PORT ROYALE LN
SURPRISE, AZ 85388-7678
Phone number: 623-776-5626
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Mailing Address
SHANE JOHNSON OTR/L
18480 W PORT ROYALE LN
SURPRISE, AZ 85388-7678
Phone number: 623-776-5626
Copy
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