Individual
MELISSA JYNELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1221 BOONES LICK RD, SAINT CHARLES, MO 63301-2328
(636) 946-6140
Mailing address
1880 CAPOSELE LN, HAZELWOOD, MO 63042-1309
(314) 495-1443
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010039895
MO
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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