Provider Demographics
NPI:1053919977
Name:JOHNSON, CARLENE E (OTD,OTR/L)
Entity type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 PEYTONSVILLE ARNO RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE GROVE
Mailing Address - State:TN
Mailing Address - Zip Code:37046
Mailing Address - Country:US
Mailing Address - Phone:615-944-5649
Mailing Address - Fax:
Practice Address - Street 1:6480 PEYTONSVILLE ARNO RD
Practice Address - Street 2:
Practice Address - City:COLLEGE GROVE
Practice Address - State:TN
Practice Address - Zip Code:37046
Practice Address - Country:US
Practice Address - Phone:615-944-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000001542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty