MEDICARE: MICHELE M JOHNSON LMT, NCTMB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0000048	WI

General Provider Information

NPI Number	:	1578896098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE M JOHNSON LMT, NCTMB

Provider Business Mailing Address
First Line	:	1477 S KNOWLES AVE
Second Line	:	S 103
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2529
Country	:	US
Telephone Number	:	715-381-3829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1477 S KNOWLES AVE
Second Line	:	S 103
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2529
Country	:	US
Telephone Number	:	715-381-3829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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