Individual
MIKKAYLA MAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1891 STATION PKWY NW, ANDOVER, MN 55304-3341
(763) 755-4275
Mailing address
15707 50TH AVE N, PLYMOUTH, MN 55446-3421
(952) 221-9990
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105555
MN
Other
Enumeration date
12/20/2017
Last updated
12/20/2017
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