Provider Demographics
NPI:1528183811
Name:JOHNSTON, SUSAN STOPPER (OT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:STOPPER
Last Name:JOHNSTON
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 1:159 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1539
Mailing Address - Country:US
Mailing Address - Phone:401-421-8178
Mailing Address - Fax:
Practice Address - Street 1:159 BROWN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1539
Practice Address - Country:US
Practice Address - Phone:401-421-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT00078224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOT00078OtherOCCUPATIONAL THERAPIST