Basic Information
| Provider Information | |||||||||
| NPI: | 1477821718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | DUDYCHA | ||||||||
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| Credential: | C.O.T.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3095 85TH ST | ||||||||
| Address2: | |||||||||
| City: | FREDERIC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548374914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153275667 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2448 S 102ND ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532272466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143292500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2011 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1024-27 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.