Provider Demographics
NPI:1154066918
Name:JOHNS, JESSICA MARIE (MS OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:JOHNS
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 KESTREL ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2775
Mailing Address - Country:US
Mailing Address - Phone:850-319-1722
Mailing Address - Fax:
Practice Address - Street 1:201 SEAGRASS DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-2597
Practice Address - Country:US
Practice Address - Phone:850-749-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist