Provider Demographics
NPI:1427247394
Name:JOHNSON, JANE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W RUSSELL ST
Mailing Address - Street 2:STE. 109
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1160
Mailing Address - Country:US
Mailing Address - Phone:734-429-0208
Mailing Address - Fax:
Practice Address - Street 1:420 W RUSSELL ST
Practice Address - Street 2:STE. 109
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1160
Practice Address - Country:US
Practice Address - Phone:734-429-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9105000235225XH1200X
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand