Healthcare Provider Details

I. General information

NPI: 1932064193
Provider Name (Legal Business Name): JOHANNA MARIE CANO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 4TH ST SW
FOREST LAKE MN
55025-1536
US

IV. Provider business mailing address

3080 HAZELWOOD ST APT 312
MAPLEWOOD MN
55109-1236
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107793
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: