Provider Demographics
NPI:1689955593
Name:JOHNSON, SARAH ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6776 LAKE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1191
Mailing Address - Country:US
Mailing Address - Phone:651-784-7007
Mailing Address - Fax:651-784-7992
Practice Address - Street 1:6776 LAKE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-1191
Practice Address - Country:US
Practice Address - Phone:651-784-7007
Practice Address - Fax:651-784-7992
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102828225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics