Healthcare Provider Details

I. General information

NPI: 1801042627
Provider Name (Legal Business Name): KERRIE JEAN JOHNSON ANTHONY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRIE JEAN JOHNSON OTR/L

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13003 LARKSPUR LN
PROSPECT KY
40059-9714
US

IV. Provider business mailing address

13003 LARKSPUR LN
PROSPECT KY
40059-9714
US

V. Phone/Fax

Practice location:
  • Phone: 502-387-4254
  • Fax: 502-228-4256
Mailing address:
  • Phone: 502-387-4254
  • Fax: 502-228-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberR0033
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR0033
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberR0033
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License NumberR0033
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: