Provider Demographics
NPI:1386334548
Name:JOHNSON, MCKENZIE PAIGE (OTA)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:PAIGE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GALCHUTT ST
Mailing Address - Street 2:
Mailing Address - City:GALCHUTT
Mailing Address - State:ND
Mailing Address - Zip Code:58075-8108
Mailing Address - Country:US
Mailing Address - Phone:701-403-4042
Mailing Address - Fax:
Practice Address - Street 1:123 2ND ST N,
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075
Practice Address - Country:US
Practice Address - Phone:701-642-7047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty