| Doctor Name: | GARY S JOHNSON |
| NPI Number: | 1619269891 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | OT |
| License Number: | 056009329 |
| Business Practice Address: | 2615 Harrison St Bellwood, IL - 601042450 |
| Business Phone Number: | 7084930199 |
| Business Fax Number: | 7084939683 |
| Mailing Address: | 2615 Harrison St, BELLWOOD |
| State: | IL |
| Postal Code: | 601042450 |
| Phone Number: | 7084930199 |
| Fax Number: | 7084939683 |
| NPI Enumeration Date: | 05/06/2011 |
| NPI Last Update Date: | 05/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 056009329 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |