Shane Johnson, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2743 Issued in AZ

Practice address

18480 W Port Royale LN
Surprise, AZ 85388-7678

Phone

(623) 776-5626

NPI assigned

Jun 15, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1548610041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18480 W PORT ROYALE LN",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853887678",
            "telephone_number": "623-776-5626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18480 W PORT ROYALE LN",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853887678",
            "telephone_number": "623-776-5626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHANE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AZ",
            "license": "2743",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Rae Johnson, L.P.N.
• Elijah Alexander Johnson
• Hailie Renee Johnson
• Jaclyn Johnson
• Rodney Jamar Johnson, RN
• David A Johnston, PT, DPT
• Shardia Joiner
• Saipress Breaun Jones- Dexter
• Juliana Jordan
• Melissa Jordan

• Occupational Therapist in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Occupational Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; 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.