Individual
OCTAVIA J JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7307 W LISBON AVE, MILWAUKEE, WI 53216-2744
(920) 441-6238
Mailing address
7307 W LISBON AVE, MILWAUKEE, WI 53216-2744
(920) 441-6238
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1
TRANSPORTATION
—
Enumeration date
09/08/2025
Last updated
09/08/2025
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