Individual
KELLY ANN MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
330 W POWELL BLVD, GRESHAM, OR 97030-7051
(916) 968-6320
Mailing address
4506 SE 33RD CT, GRESHAM, OR 97080-8250
(916) 968-6320
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
445164
OR
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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