Individual
MRS. JEANETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T. R./L
Contact information
Practice address
2208 N YELLOWOOD AVE, BROKEN ARROW, OK 74012-9102
(918) 286-1261
Mailing address
2208 N YELLOWOOD AVE, BROKEN ARROW, OK 74012-9102
(918) 286-1261
(918) 286-1265
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
500
OK
Other
Enumeration date
06/28/2006
Last updated
07/09/2007
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