Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5900 | AZ |
NPI | 1003215906 |
---|---|
Provider Name | Shaeleen Johnston |
First Address | Cottonwood, AZ 86326-4123 |
Second Address | Cottonwood, AZ 86326-4123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 15/08/2014 |