Individual
JACQUELINE RUTH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8840 CYPRESS WATERS BLVD, SUITE 300, COPPELL, TX 75019-4594
(800) 929-2304
Mailing address
296 SW FLORIDA LOOP, MADISON, FL 32340-8481
(850) 464-7612
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT3975
FL
Other
Enumeration date
02/29/2016
Last updated
02/29/2016
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