Individual
MRS. KELLY RENEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAOTRL
Contact information
Practice address
2422 PARTRIDGE LOOP, POST FALLS, ID 83854-4944
(208) 819-9363
Mailing address
2422 PARTRIDGE LOOP, POST FALLS, ID 83854-4944
(208) 819-9363
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
553
SD
225XP0200X
Pediatric Occupational Therapist
Primary
OT-840
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5834280
—
SD
Enumeration date
03/28/2007
Last updated
07/31/2008
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