Provider Demographics
NPI:1952742504
Name:JOHNSTON, KELLY (MT-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1823
Mailing Address - Country:US
Mailing Address - Phone:724-602-3301
Mailing Address - Fax:
Practice Address - Street 1:205 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1823
Practice Address - Country:US
Practice Address - Phone:724-602-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist