Individual
MS. RICIA RAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA/L
Contact information
Practice address
4415 WEST 36 1/2 STREET, ST. LOUIS PARK, MN 55416
(952) 927-9717
(952) 927-7687
Mailing address
4415 WEST 36 1/2 STREET, ST. LOUIS PARK, MN 55416
(952) 927-9717
(952) 927-7687
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
201244
MN
224Z00000X
Occupational Therapy Assistant
201244
MS
Other
Enumeration date
08/06/2007
Last updated
12/15/2011
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