Kelly Renee Johnson, MAOTRL

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT-840 Issued in ID

Practice address

2422 Partridge Loop
Post Falls, ID 83854-4944

Phone

(208) 819-9363

NPI assigned

Mar 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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.

• Superstars Occupational Therapy for Kids, PLLC

  • Pediatric Occupational Therapist
  • Post Falls, ID
  • NPI 1265698245

  Pediatrics

  NPD (past) Authorized official

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217462400000",
    "number": "1760501993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 PARTRIDGE LOOP",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838544944",
            "telephone_number": "208-819-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 PARTRIDGE LOOP",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838544944",
            "telephone_number": "208-819-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MAOTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2008-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SD",
            "license": "553",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ID",
            "license": "OT-840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5834280",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeannie Dalton LCSW
• Mary Louise Jensen, LPC
• Darren James Jerome
• Christopher Frederic Jessen, MD
• JMJ Family Health
• Pierce Johnson, PT
• Scott Alan Johnson, D.D.S.
• Elizabeth Johnston Borsella
• Joseph J McGinnis OD PA
• Joseph M Bowen MD PC

• Pediatric Occupational Therapist in Post Falls, ID
• Providers in Post Falls, ID by specialty
• Pediatric Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.