Individual
MISS JILLIAN MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
301 PINEHAVEN STREET EXT, LAURENS, SC 29360-2671
(864) 984-6584
(864) 984-6464
Mailing address
301 PINEHAVEN STREET EXT, LAURENS, SC 29360-2671
(864) 984-6584
(864) 984-6464
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3033
SC
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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