Provider Demographics
NPI:1265114144
Name:JOHNSTON, JENNINE MAREE (OT)
Entity type:Individual
Prefix:
First Name:JENNINE
Middle Name:MAREE
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 1:2324 ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1128
Mailing Address - Country:US
Mailing Address - Phone:713-392-1224
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 950
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5204
Practice Address - Country:US
Practice Address - Phone:832-325-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104010225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics