Healthcare Provider Details

I. General information

NPI: 1093373268
Provider Name (Legal Business Name): KATRINA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 GYPSIE LN
EAST BEND NC
27018-8815
US

IV. Provider business mailing address

3723 GYPSIE LN
EAST BEND NC
27018-8815
US

V. Phone/Fax

Practice location:
  • Phone: 732-275-2344
  • Fax:
Mailing address:
  • Phone: 732-275-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: