Individual
MRS. JESSICA FORTUNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
38 LAKES AT LITCHFIELD DR, PAWLEYS ISLAND, SC 29585-5768
(843) 237-0343
Mailing address
9042 GATEWICK CT, MYRTLE BEACH, SC 29579-4172
(321) 615-2533
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3102
SC
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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