Provider Demographics
NPI:1245636828
Name:JOHNSON, KAITLIN R (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-2708
Mailing Address - Country:US
Mailing Address - Phone:401-996-1782
Mailing Address - Fax:
Practice Address - Street 1:612 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4236
Practice Address - Country:US
Practice Address - Phone:401-996-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11404225X00000X
RIOT02035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist