Healthcare Provider Details

I. General information

NPI: 1225379738
Provider Name (Legal Business Name): DAWN K JOHNSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BRIDGE CREEK LN
AUGUSTA WI
54722-2603
US

IV. Provider business mailing address

4103 60TH ST
KENOSHA WI
53144-2509
US

V. Phone/Fax

Practice location:
  • Phone: 414-750-4980
  • Fax:
Mailing address:
  • Phone: 262-652-1111
  • Fax: 262-652-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5242-26
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118678
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5242-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: