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MARY DIANE JOHNSON TMD OUTLET
NPI 1649389388
Orthotic Fitter in Lebanon, MO

Active since August 29, 2006
702 S MONROE, LEBANON, MO 65536(417) 588-3404(417) 588-3404 Get Directions Write a Review

NPPES record last updated: June 16, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Diane Johnson Tmd Outlet NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY DIANE JOHNSON TMD OUTLET (NPI 1649389388) is a healthcare organization registered as an orthotic fitter in Lebanon, Missouri and active in the NPI registry since August 2006. The organization lists Mary D Johnson, Owner/abc Certified Fitter (rem0094, as its authorized official.

NPPES Registry Identity

NPI1649389388
Entity TypeOrganization
Primary Taxonomy225000000X
Legal Business NameMARY DIANE JOHNSON TMD OUTLET
Location Address702 S MONROELebanon, MO 65536-3570
Mailing Address702 S MonroeLebanon, MO 65536-3570 · (417) 588-3404 · Fax (417) 588-3404
Phone(417) 588-3404
Fax(417) 588-3404
Organization SubpartNo
Authorized OfficialMary D JohnsonOwner/abc Certified Fitter (rem0094 · (417) 588-3404
Enumeration DateAugust 29, 2006
Last NPPES UpdateJune 16, 2008
✔ NPI 1649389388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthotic FitterRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225000000X
Definition
An individual trained in the management of fitting prefabricated orthoses.
702 S MONROE, Lebanon, MO 65536
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Other Identifiers 3

Other=========TMDMO · St. John's Premier Ins.
Medicare NSC0780990001MO
Other174584MO · Blue Cross/blue Shield

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Diane Johnson Tmd Outlet's NPI number?

The NPI number for Mary Diane Johnson Tmd Outlet is 1649389388. It was assigned to this organization in the NPPES registry on August 29, 2006.

Where is Mary Diane Johnson Tmd Outlet located?

Mary Diane Johnson Tmd Outlet is located at 702 S Monroe, Lebanon, MO 65536. The listed phone number is (417) 588-3404.

What is Mary Diane Johnson Tmd Outlet's specialty?

The primary specialty registered for this NPI is Orthotic Fitter with taxonomy code 225000000X.

When was this NPI record last updated?

The NPPES record for Mary Diane Johnson Tmd Outlet was last updated on June 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.