Provider Demographics
NPI:1215563507
Name:JOHNSTON, SUE MARGARET (OTA)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:MARGARET
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4272
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29608-4272
Mailing Address - Country:US
Mailing Address - Phone:864-982-7233
Mailing Address - Fax:
Practice Address - Street 1:4501 OLD SPARTANBURG RD STE 7
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4105
Practice Address - Country:US
Practice Address - Phone:864-292-5154
Practice Address - Fax:864-292-5154
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4806224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant