Provider Demographics
NPI:1770237992
Name:JOHNSON, CATHERINE CLARE (MSOTR)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CLARE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 BAVARIA DR APT 307
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8262
Mailing Address - Country:US
Mailing Address - Phone:719-208-9733
Mailing Address - Fax:
Practice Address - Street 1:1130 W WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2726
Practice Address - Country:US
Practice Address - Phone:719-574-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0000587225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics