Healthcare Provider Details

I. General information

NPI: 1730433095
Provider Name (Legal Business Name): KATHRYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 PLUMAS ST
RENO NV
89509-4515
US

IV. Provider business mailing address

3101 PLUMAS ST
RENO NV
89509-4515
US

V. Phone/Fax

Practice location:
  • Phone: 775-433-2700
  • Fax:
Mailing address:
  • Phone: 775-433-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number12-1159
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: