Provider Demographics
NPI:1861068942
Name:JOHNSON, VALERIE GISELLE (MSOT)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:GISELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:MISS
Other - First Name:VALERIE
Other - Middle Name:GISELLE
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 KESTREE DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-4009
Mailing Address - Country:US
Mailing Address - Phone:603-425-8508
Mailing Address - Fax:
Practice Address - Street 1:219 GERALD DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4111
Practice Address - Country:US
Practice Address - Phone:864-757-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13841225X00000X
NH3153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist