Kevin Richard Johnson, COTA
Individual provider Active NPI Occupational Therapy Assistant · Weyauwega, WI
NPI 1962654301 · NPPES record last updated Oct 16, 2008
Key facts
- NPI
- 1962654301
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 1141-027 (WI)
- Practice address
- 717 E Alfred St
Weyauwega, WI 54983-9024 - Phone
- (920) 867-3121
- Fax
- (920) 867-3997
- NPI assigned
- Oct 16, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 1141-027 | WI | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 1141-027 | WI | Yes |
Addresses
Primary practice location
717 E Alfred St
Weyauwega, WI 54983-9024
Mailing address
717 E Alfred St
Weyauwega, WI 54983-9024
Phone (920) 867-3121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1141-027 | Other | WI | NPI |
Other providers in Weyauwega, WI
- Extendicare Homes, Inc.
- Craig M Gorst
- Victoria Hillskotter
- Iris Health Clinic LLC
- Tatiana Jansen
- Jana Marie Kizewski
- Valerie Mahoney
- Angela Jean Moderson
- Northwest Journey - Waupaca County
- Hope Marie Oshefsky
All providers in Weyauwega, WI · Occupational Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2008. 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.