Provider Demographics
NPI:1184664740
Name:JOHNSON, JANE (OT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N BEDELL AVE
Mailing Address - Street 2:#B
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8007
Mailing Address - Country:US
Mailing Address - Phone:830-774-1556
Mailing Address - Fax:830-774-6150
Practice Address - Street 1:2201 N BEDELL AVE
Practice Address - Street 2:#B
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8007
Practice Address - Country:US
Practice Address - Phone:830-774-1556
Practice Address - Fax:830-774-6150
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOT110488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4300OtherBLUE CROSS ID NUMBER
TX8G0978Medicare ID - Type Unspecified
TX8T4300OtherBLUE CROSS ID NUMBER