Provider Demographics
NPI:1073521522
Name:JOHNSTON, VICKI (OTR)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S BELL AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:KS
Mailing Address - Zip Code:67554-3608
Mailing Address - Country:US
Mailing Address - Phone:620-257-3685
Mailing Address - Fax:
Practice Address - Street 1:619 S CLARK AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3003
Practice Address - Country:US
Practice Address - Phone:620-257-5173
Practice Address - Fax:620-257-3002
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1701179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS120090OtherBCBS PROV. NO.
KSP85923Medicare UPIN
KS120090Medicare ID - Type Unspecified