Individual
JENIFER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
6610 INTERSTATE 35 N, WACO, TX 76705-1136
(254) 235-7604
(254) 235-7612
Mailing address
6610 INTERSTATE 35 N, WACO, TX 76705-1136
(254) 235-7604
(254) 235-7612
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
115118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115118
OCCUPATIONAL THERAPY LIC #
TX
Enumeration date
11/12/2012
Last updated
11/12/2012
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