Provider Demographics
NPI:1619197258
Name:JOHNSON, CATHERYN YVETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CATHERYN
Middle Name:YVETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 NW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5420
Mailing Address - Country:US
Mailing Address - Phone:352-336-6872
Mailing Address - Fax:
Practice Address - Street 1:4703 NW 53RD AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3415
Practice Address - Country:US
Practice Address - Phone:352-375-8806
Practice Address - Fax:352-375-9984
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888141300Medicaid