Basic Information
| Provider Information | |||||||||
| NPI: | 1386216984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KINSEY | ||||||||
| MiddleName: | MARIAH | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 808 | ||||||||
| Address2: | |||||||||
| City: | RIDGEWAY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241480808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767343965 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3907A W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274071303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362799008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2021 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 14238 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.