Provider Demographics
NPI:1386999423
Name:JOHNSON, KARI LYNN (OTR)
Entity type:Individual
Prefix:MISS
First Name:KARI
Middle Name:LYNN
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 1:1605 S CAMEO WAY
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1224
Mailing Address - Country:US
Mailing Address - Phone:651-208-2155
Mailing Address - Fax:
Practice Address - Street 1:2901 INDIANA BLVD
Practice Address - Street 2:APT. 409
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1520
Practice Address - Country:US
Practice Address - Phone:651-208-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist