Healthcare Provider Details

I. General information

NPI: 1043168214
Provider Name (Legal Business Name): JADE ARIANA JOHNSON OTR/L, MSOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 FABER PLACE DR STE 420
NORTH CHARLESTON SC
29405-8594
US

IV. Provider business mailing address

585 EZEKIEL BLVD UNIT 105
SPARTANBURG SC
29303-6916
US

V. Phone/Fax

Practice location:
  • Phone: 843-894-7374
  • Fax: 843-278-8599
Mailing address:
  • Phone: 229-848-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7918
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: