Provider Demographics
NPI:1245700624
Name:JOHNSON, CAITLIN ANN (COTA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ANN
Other - Last Name:KNIGHTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W9076 570TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-4528
Mailing Address - Country:US
Mailing Address - Phone:715-441-0192
Mailing Address - Fax:
Practice Address - Street 1:1505 ORRIN RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-1074
Practice Address - Country:US
Practice Address - Phone:715-262-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5557-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant