Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119006453 | VA |
Y | 225X00000X | Occupational Therapist | 162046 | KY |
NPI | 1003265513 |
---|---|
Provider Name | Natalie Johnstone |
First Address | Kennesaw, GA 30144-7098 |
Second Address | London, KY 40741-6668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 06/06/2016 |