Taylor Elizabeth Johnson, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-2049 Issued in ID

Practice address

820 Elm Street
St. Maries, ID 83864

Phone

(208) 245-4576

Fax

(208) 245-2138

NPI assigned

Apr 30, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Taylor E Pena Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1801450374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 ELM STREET",
            "city": "ST. MARIES",
            "state": "ID",
            "postal_code": "83864",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 ELM STREET",
            "city": "ST. MARIES",
            "state": "ID",
            "postal_code": "83864",
            "telephone_number": "208-245-4576",
            "fax_number": "208-245-2138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 S Division Ave",
            "address_purpose": "LOCATION",
            "city": "Sandpoint",
            "state": "ID",
            "postal_code": "838641759",
            "country_code": "US",
            "telephone_number": "208-265-4514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TAYLOR",
        "middle_name": "ELIZABETH",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-30",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-2049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "PENA",
            "middle_name": "E",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in St. Maries, ID
• Providers in St. Maries, ID by specialty
• Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.