Healthcare Provider Details

I. General information

NPI: 1164338646
Provider Name (Legal Business Name): AMY LYNN JOHNSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MINNESOTA AVE NW
BEMIDJI MN
56601-3060
US

IV. Provider business mailing address

502 MINNESOTA AVE NW
BEMIDJI MN
56601-3060
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-3119
  • Fax:
Mailing address:
  • Phone: 218-333-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104024
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: