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General NPI Number Information
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NPI Number | 1124246426
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Entity Type | Individual
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Provider Name | MICHELLE LEE JOHNSON OTR
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 5111 E 21ST ST N
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City | WICHITA
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State | KS
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Zip | 67208-1606
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Country | US
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Telephone | 316-651-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 LOOMIS DR
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City | AUGUSTA
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State | KS
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Zip | 67010-1721
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Country | US
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Telephone | 316-393-8843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 17-00946
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License Number State | KS
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