Provider Demographics
NPI:1124663166
Name:JORDAN, KATHY JOHNSON (OTR)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JOHNSON
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-4902
Mailing Address - Country:US
Mailing Address - Phone:281-222-4547
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR STE 12
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4968
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:281-655-0762
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics