Jodi Johnson
Individual provider Active NPI Occupational Therapy Assistant · Sault Saint Marie, MI
NPI 1629465935 · NPPES record last updated Apr 24, 2015
Key facts
- NPI
- 1629465935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 5202007654 (MI)
- Practice address
- 1011 Merridian St
Sault Saint Marie, MI 49783 - Phone
- (906) 635-1518
- NPI assigned
- Apr 24, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5202007654 | MI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5202007654 | MI | Yes |
Addresses
Primary practice location
1011 Merridian St
Sault Saint Marie, MI 49783
Mailing address
1651 Riverside Dr Apt B4
Sault Sainte Marie, MI 49783
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.