Provider Demographics
NPI:1427149574
Name:JOHNSON, JANIS ANN (OTR)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JANIS
Other - Middle Name:ANN
Other - Last Name:ZIMNIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1 VETERANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-3884
Mailing Address - Fax:612-467-5309
Practice Address - Street 1:1 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3884
Practice Address - Fax:612-467-5309
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102564225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA444174OtherNBCOT