Healthcare Provider Details

I. General information

NPI: 1568009686
Provider Name (Legal Business Name): ISABELLA KATHRYN NOVAK MSOT, OTR/L, BCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISABELLA JOHNSON MSOT, OTR/L, BCP

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BUFORD VILLAGE WAY SUITE 229
BUFORD GA
30518
US

IV. Provider business mailing address

337 E WILSON ST
MILWAUKEE WI
53207-1571
US

V. Phone/Fax

Practice location:
  • Phone: 678-482-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT008208
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: