Provider Demographics
NPI:1770118689
Name:JOHNSON, KARELY VERONICA (COTA/L)
Entity type:Individual
Prefix:
First Name:KARELY
Middle Name:VERONICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:SENATH
Mailing Address - State:MO
Mailing Address - Zip Code:63876-0042
Mailing Address - Country:US
Mailing Address - Phone:573-344-5727
Mailing Address - Fax:
Practice Address - Street 1:1120 FALCON DR
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3825
Practice Address - Country:US
Practice Address - Phone:573-888-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019041287224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant