Individual
KIM BERNADETTE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
235 REMINGTON BLVD, SUITE I, BOLINGBROOK, IL 60440-5826
(630) 312-8022
(630) 312-8660
Mailing address
235 REMINGTON BLVD, SUITE I, BOLINGBROOK, IL 60440-5826
(630) 312-8022
(630) 312-8660
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057001876
IL
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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