MEDICARE: KELSEY NICOLE STEVENS JOHNSON MS, OTR/L

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	225X00000X	Occupational Therapist	1704	NE

General Provider Information

NPI Number	:	1962841619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY NICOLE STEVENS JOHNSON MS, OTR/L

Provider Business Mailing Address
First Line	:	300 N 2ND ST
Second Line	:
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-3151
Country	:	US
Telephone Number	:	402-373-5531
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N 2ND ST
Second Line	:
City	:	BLOOMFIELD
State	:	NE
Zip	:	68718-3151
Country	:	US
Telephone Number	:	402-373-5531
Fax Number	:

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

Provider Enumeration Date	:	06/16/2013
Last Update Date	:	07/10/2023

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