Kathy Marie Johnson, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

001190 Issued in NY

Practice address

5225 Nesconset Hwy
30
Port Jefferson Station, NY 11776-2053

Phone

(631) 473-4284

NPI assigned

Oct 15, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New York Therapy Placement Services

  • Early Intervention Provider Agency
  • Port Jefferson Station, NY
  • NPI 1982060489
  NPD (past)

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

{
    "created_epoch": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287100800000",
    "number": "1124338744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 SILLS CT",
            "city": "CENTERPORT",
            "state": "NY",
            "postal_code": "117211634",
            "telephone_number": "631-754-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 NESCONSET HWY",
            "address_2": "30",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762053",
            "telephone_number": "631-473-4284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATHY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2010-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "001190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPY LICENSE NUMBER",
            "identifier": "001190",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerry G Ninia MDPC
• Joanne Della Valle LCSW P.C.
• John T. Mather Memorial Hospital
• Shirley Johnson-Hall, MD
• Colleen Breen Johnson, PA-C
• Kristin Lynn Johnson, R.N.
• Melissa Johnson, M.S.ED.
• Sandy J Johnson, LMFT
• Mary Ellen M Johnston, L-RCSW
• Toni Lee Johnston, NP

• Occupational Therapist in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; 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.