Provider Demographics
NPI:1356832976
Name:SAULSBERRY, JOHNNEA CHRISTINE
Entity Type:Individual
Prefix:
First Name:JOHNNEA
Middle Name:CHRISTINE
Last Name:SAULSBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 W 133RD ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3347
Mailing Address - Country:US
Mailing Address - Phone:913-948-4223
Mailing Address - Fax:816-222-0679
Practice Address - Street 1:3715 W 133RD ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3347
Practice Address - Country:US
Practice Address - Phone:913-948-4223
Practice Address - Fax:816-222-0679
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03379225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-03379OtherKANSAS OT LICENSE