Individual
MR. KEVIN RICHARD JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
717 E ALFRED ST, WEYAUWEGA, WI 54983-9024
(920) 867-3121
(920) 867-3997
Mailing address
717 E ALFRED ST, WEYAUWEGA, WI 54983-9024
(920) 867-3121
(920) 867-3997
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1141-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1141-027
NPI
WI
Enumeration date
10/16/2008
Last updated
10/16/2008
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