Provider Demographics
NPI:1801042627
Name:ANTHONY, KERRIE JEAN JOHNSON (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KERRIE
Middle Name:JEAN JOHNSON
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KERRIE
Other - Middle Name:JEAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:13003 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9714
Mailing Address - Country:US
Mailing Address - Phone:502-387-4254
Mailing Address - Fax:502-228-4256
Practice Address - Street 1:13003 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9714
Practice Address - Country:US
Practice Address - Phone:502-387-4254
Practice Address - Fax:502-228-4256
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0033225XN1300X, 225XP0200X, 225XP0019X, 225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification