Provider Demographics
NPI:1417182767
Name:LAJOM, JOHNSTON (OT)
Entity Type:Individual
Prefix:
First Name:JOHNSTON
Middle Name:
Last Name:LAJOM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 E DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8252
Mailing Address - Country:US
Mailing Address - Phone:480-277-6913
Mailing Address - Fax:
Practice Address - Street 1:2071 E DETROIT ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8252
Practice Address - Country:US
Practice Address - Phone:480-277-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist