Individual
JACLYN MAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
6250 S 40TH ST UNIT 4006, PHOENIX, AZ 85042-5277
(612) 747-2489
Mailing address
6250 S 40TH ST UNIT 4006, PHOENIX, AZ 85042-5277
(612) 747-2489
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTH-009675
AZ
Other
Enumeration date
06/09/2021
Last updated
05/20/2025
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