Ricia Rae Johnson, OTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

201244 Issued in MN

Practice address

4415 West 36 1/2 Street
St. Louis Park, MN 55416

Phone

(952) 927-9717

Fax

(952) 927-7687

NPI assigned

Aug 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Ricia Rae Glockzin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1639360514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 WEST 36 1/2 STREET",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "952-927-9717",
            "fax_number": "952-927-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 WEST 36 1/2 STREET",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "952-927-9717",
            "fax_number": "952-927-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RICIA",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "OTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MS",
            "license": "201244",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MN",
            "license": "201244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICIA",
            "last_name": "GLOCKZIN",
            "middle_name": "RAE",
            "prefix": "MRS.",
            "credential": "OTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael Gene Johnson, DDS
• Michael Joel Johnson, O.D.
• Nicole Johnson, ATC
• Paul G Johnson, M.D.
• Randall D Johnson, M.D.
• Robert W Johnson, M.D.
• Savannah Johnson
• Shannon Johnson
• Sharon M Johnson, R.D.
• Stella Johnson

• Occupational Therapy Assistant in St. Louis Park, MN
• Providers in St. Louis Park, MN by specialty
• Occupational Therapy Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; 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.