Brenna Stanley Johnson, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

107063 Issued in TX

Practice address

817 N Mound St
Nacogdoches, TX 75961

Phone

(936) 564-6907

Fax

(936) 564-0509

NPI assigned

Aug 4, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hettie Legg & Associates

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Nacogdoches, TX
  • NPI 1396908232

  Occupational Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1508874637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614427",
            "telephone_number": "936-564-6907",
            "fax_number": "936-564-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 N MOUND ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75961",
            "telephone_number": "936-564-6907",
            "fax_number": "936-564-0509"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "817 N Mound St",
            "address_purpose": "LOCATION",
            "city": "Nacogdoches",
            "state": "TX",
            "postal_code": "75961",
            "country_code": "US",
            "telephone_number": "936-564-6907",
            "fax_number": "936-564-0509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENNA",
        "middle_name": "STANLEY",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "107063",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "107063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS #",
            "identifier": "659657",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1637803-02",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1637803-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Smith MD PA
• Adrian Craig Jessie, MD
• Billy Jobe
• John P Gray MD PA
• Cassandra Johnson White, LMT
• Ray Thomas Johnston, L.C.S.W., S.A.P.
• Elizabeth Joines
• Carl R Jones, DO
• Hannah Wagley Jones, LPC
• Je'Lisa Nicole Jordan, MS, CCC/SLP

• Pediatric Occupational Therapist in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Pediatric Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.