Provider Demographics
NPI:1104000124
Name:GABRIEL JOHNSON, JANICE KAY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:KAY
Last Name:GABRIEL JOHNSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 8TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072
Mailing Address - Country:US
Mailing Address - Phone:701-845-5834
Mailing Address - Fax:
Practice Address - Street 1:744 8TH AVE NW
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2000
Practice Address - Country:US
Practice Address - Phone:701-840-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND30517OtherBC/BS
ND55185Medicaid
ND713357Medicare PIN