Provider Demographics
NPI:1366867137
Name:JOHNSON, SARA JANICE (MSOTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANICE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JANICE
Other - Last Name:JOHNSON-KERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9295 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-3141
Mailing Address - Country:US
Mailing Address - Phone:440-409-2365
Mailing Address - Fax:
Practice Address - Street 1:7377 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-6000
Practice Address - Country:US
Practice Address - Phone:440-885-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT006342225X00000X
OHOT-6342225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist