Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0145 | SD |
NPI | 1003360868 |
---|---|
Provider Name | Annemarie Johnson |
First Address | Black Hawk, SD 57718-9343 |
Second Address | Black Hawk, SD 57718-9343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2016 |
Last Update Date | 10/08/2016 |