Provider Demographics
NPI:1659022531
Name:JOHNSTON, HAVEN MICHAEL (LOTR)
Entity Type:Individual
Prefix:MR
First Name:HAVEN
Middle Name:MICHAEL
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 BROWNLEE RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225-8262
Mailing Address - Country:US
Mailing Address - Phone:318-450-5653
Mailing Address - Fax:
Practice Address - Street 1:109 MCCLENDON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-8052
Practice Address - Country:US
Practice Address - Phone:318-387-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA329813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist