Provider Demographics
NPI:1225481781
Name:JOHNSON, KATTIA-NYDE CHAMPAGNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATTIA-NYDE
Middle Name:CHAMPAGNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:K
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1104 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1564
Mailing Address - Country:US
Mailing Address - Phone:561-249-9507
Mailing Address - Fax:
Practice Address - Street 1:1104 LAKEFRONT DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35824-1564
Practice Address - Country:US
Practice Address - Phone:561-249-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALOT4563225XP0200X
OT4563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist