Individual
MARY BETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
7880 SERENE COURT, CROSS PLAINS, WI 53528
(608) 798-1636
Mailing address
7880 SERENE COURT, CROSS PLAINS, WI 53528
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
80
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40542200
—
WI
Enumeration date
04/28/2008
Last updated
04/28/2008
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