Provider Demographics
NPI:1487808341
Name:CHAMPNEY, JOHANNA RUTH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:RUTH
Last Name:CHAMPNEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 N MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-3537
Mailing Address - Country:US
Mailing Address - Phone:631-873-4502
Mailing Address - Fax:
Practice Address - Street 1:581 N MONROE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-3537
Practice Address - Country:US
Practice Address - Phone:631-873-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011884-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist