Individual
JENNIFER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1104 WESLEY AVE, BRYAN, OH 43506-2579
(419) 636-5071
Mailing address
413 E WASHINGTON ST, MONTPELIER, OH 43543-1575
(419) 551-1189
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
OTA-05816
OH
Other
Enumeration date
08/29/2014
Last updated
08/29/2014
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