Provider Demographics
NPI:1336373083
Name:JOHNSON, JANE PRUETT (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:PRUETT
Last Name:JOHNSON
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 1:122 FOLLY BEND DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8533
Mailing Address - Country:US
Mailing Address - Phone:864-538-4556
Mailing Address - Fax:
Practice Address - Street 1:122 FOLLY BEND DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-8533
Practice Address - Country:US
Practice Address - Phone:864-538-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48225X00000X
GAOT000732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist