Provider Demographics
NPI:1184164048
Name:JOHNSON, CATHERINE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:52069-9742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 N SIMPSON ST
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:IA
Practice Address - Zip Code:52069-9742
Practice Address - Country:US
Practice Address - Phone:563-689-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006186225X00000X
IA01282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist