Healthcare Provider Details

I. General information

NPI: 1821913351
Provider Name (Legal Business Name): ELIZABETH JOHNSTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 N THORNE AVE
FRESNO CA
93704-5936
US

IV. Provider business mailing address

1719 N THORNE AVE
FRESNO CA
93704-5936
US

V. Phone/Fax

Practice location:
  • Phone: 559-824-6472
  • Fax:
Mailing address:
  • Phone: 559-824-6472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: