Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 001791 | MO |
NPI | 1851643423 |
---|---|
Provider Name | Kelli Almaria Johnson |
First Address | Lees Summit, MO 64064-3020 |
Second Address | Shawnee Mission, KS 66204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 08/10/2012 |