Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | .0002011 | CO |
NPI | 1235758459 |
---|---|
Provider Name | Michelle Anne Johnston |
First Address | Colorado Springs, CO 80920-8000 |
Second Address | Colorado Springs, CO 80920-8000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |