Provider Demographics
NPI:1669674636
Name:JOHNSTON, JAMIE NANETTE (OTR)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NANETTE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:NANETTE
Other - Last Name:RUBELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:105 DIAMOND BAR LN
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-7300
Mailing Address - Country:US
Mailing Address - Phone:307-347-4636
Mailing Address - Fax:
Practice Address - Street 1:105 DIAMOND BAR LN
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-7300
Practice Address - Country:US
Practice Address - Phone:307-347-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist