Active NPI
Kimberly Ann Johnson
- Occupational Therapy Assistant
- Oldtown, MD
National Provider Identifier
1255965596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- C2134
- Practice address
- 16512 Honeybunch LN SE
Oldtown, MD 21555-1325 - Phone
- (240) 727-5083
- NPI assigned
- Feb 25, 2020
- Last updated
- Feb 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | C2134 | WV | Primary |
Addresses
Primary practice location
16512 Honeybunch LN SE
Oldtown, MD 21555-1325
Mailing address
16512 Honeybunch LN SE
Oldtown, MD 21555-1325
Phone (240) 727-5083
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C2134 | WV | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582588800000",
"number": "1255965596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16512 HONEYBUNCH LN SE",
"city": "OLDTOWN",
"state": "MD",
"postal_code": "215551325",
"telephone_number": "240-727-5083"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16512 HONEYBUNCH LN SE",
"city": "OLDTOWN",
"state": "MD",
"postal_code": "215551325",
"telephone_number": "240-727-5083"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-25",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "WV",
"license": "C2134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oldtown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.