Provider Demographics
NPI:1891212189
Name:JOHNSTON, KATHLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21005 S SCHOOL RD.
Mailing Address - Street 2:
Mailing Address - City:PECUILAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21005 S SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:PECUILAR
Practice Address - State:MO
Practice Address - Zip Code:64078
Practice Address - Country:US
Practice Address - Phone:816-892-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist