Provider Demographics
NPI:1366732109
Name:JOHNSON, KAYLEE M (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:M
Other - Last Name:HASSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1469
Mailing Address - Country:US
Mailing Address - Phone:484-241-4220
Mailing Address - Fax:
Practice Address - Street 1:406 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1469
Practice Address - Country:US
Practice Address - Phone:484-241-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2692225X00000X
PAOC011094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist