Individual
JACQUELYN JOY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
111 W 36TH ST, SCOTTSBLUFF, NE 69361-4636
(308) 635-2019
Mailing address
2018 5TH AVE, SCOTTSBLUFF, NE 69361-2044
(308) 220-4573
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
747
NE
Other
Enumeration date
08/02/2011
Last updated
08/02/2011
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