Individual
MRS. KASSIDI MACEMORE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
237 MULBERRY ST, SHALLOTTE, NC 28470-4471
(336) 918-3431
Mailing address
298 SAND PIPER LN, HOLDEN BEACH, NC 28462-1961
(336) 918-3431
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
9249
NC
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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