Individual provider Active NPI

McKenna Anne Johnson, OTR/L

  • Occupational Therapist
  • Puyallup, WA
National Provider Identifier
1871241745
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT61264446 Issued in WA
Practice address
17615 85TH Avenue CT E
Puyallup, WA 98375-1902
Phone
(253) 216-2589
NPI assigned
Mar 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT61264446 WA Primary

Addresses

Primary practice location

17615 85TH Avenue CT E
Puyallup, WA 98375-1902

Mailing address

25402 139TH Ave SE
Kent, WA 98042-6608
Phone (253) 632-6440

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

LicenseStateTypeSpecialty
OT61264446WAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Little Fin Therapies, LLC CurrentSince Mar 13, 2022 Accepting new patients

Locations

17615 85th Avenue Ct E
Puyallup, WA 98375
Phone (253) 216-2589

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1871241745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25402 139TH AVE SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980426608",
            "telephone_number": "253-632-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17615 85TH AVENUE CT E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983751902",
            "telephone_number": "253-216-2589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MCKENNA",
        "middle_name": "ANNE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-10",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "OT61264446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; 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.