Provider Demographics
NPI:1225379738
Name:JOHNSON, DAWN K (OTR)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2509
Mailing Address - Country:US
Mailing Address - Phone:262-652-1111
Mailing Address - Fax:262-652-1124
Practice Address - Street 1:901 BRIDGE CREEK LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-2603
Practice Address - Country:US
Practice Address - Phone:414-750-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5242-26174400000X, 225X00000X
TX118678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist