Provider Demographics
NPI:1093935470
Name:JOHNSON, KELLY RAYHILL (OTR)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RAYHILL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:RAYHILL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:5748 N 2300 LN
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62476-3068
Mailing Address - Country:US
Mailing Address - Phone:724-833-6469
Mailing Address - Fax:
Practice Address - Street 1:5748 N 2300 LN
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:IL
Practice Address - Zip Code:62476-3068
Practice Address - Country:US
Practice Address - Phone:724-833-6469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004099A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist