Individual
MRS. KAROLINE G JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
16425 HIGHWAY 57, VANCLEAVE, MS 39565-9010
(228) 990-2476
Mailing address
16425 HIGHWAY 57, VANCLEAVE, MS 39565-9010
(228) 990-2476
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2393
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015077
—
MS
01
—
1033218524
GROUP NPI
MS
Enumeration date
06/22/2011
Last updated
08/21/2015
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