Individual
JOHANA FORTUNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
928 JAYMOR RD, SOUTHAMPTON, PA 18966-3826
(215) 330-4116
Mailing address
928 JAYMOR RD, SOUTHAMPTON, PA 18966-3826
(215) 330-4116
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC018269
PA
Other
Enumeration date
11/02/2019
Last updated
07/27/2023
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