Healthcare Provider Details

I. General information

NPI: 1568121291
Provider Name (Legal Business Name): MIKAILA JOHNSTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 N ASPEN ST
LINCOLNTON NC
28092-2113
US

IV. Provider business mailing address

931 N ASPEN ST
LINCOLNTON NC
28092-2113
US

V. Phone/Fax

Practice location:
  • Phone: 704-600-5702
  • Fax:
Mailing address:
  • Phone: 704-600-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17997
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: