Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | R0033 | KY |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | R0033 | KY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | R0033 | KY |
N | 225XP0200X | Occupational Therapist - Pediatrics | R0033 | KY |
NPI | 1801042627 |
---|---|
Provider Name | Ms. Kerrie Jean Johnson Anthony |
First Address | Prospect, KY 40059-9714 |
Second Address | Prospect, KY 40059-9714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 30/03/2015 |