Provider Demographics
NPI:1487089660
Name:JOHNSON, KRISTEN MARY (OTR/L, CLT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 SPRUCE RUN CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6944
Mailing Address - Country:US
Mailing Address - Phone:410-504-6870
Mailing Address - Fax:
Practice Address - Street 1:8608 SPRUCE RUN CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6944
Practice Address - Country:US
Practice Address - Phone:410-446-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06337225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist