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General NPI Number Information
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NPI Number | 1316233935
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Entity Type | Individual
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Provider Name | KAROLINE G JOHNSON OT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 16425 HIGHWAY 57
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City | VANCLEAVE
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State | MS
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Zip | 39565-9010
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Country | US
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Telephone | 228-990-2476
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Fax |
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Provider Business Mailing Address
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Address Line | 16425 HIGHWAY 57
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City | VANCLEAVE
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State | MS
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Zip | 39565-9010
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Country | US
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Telephone | 228-990-2476
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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 | OT2393
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License Number State | MS
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