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General NPI Number Information
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NPI Number | 1720856958
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Entity Type | Individual
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Provider Name | JASMINE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 2101 CRAWFORD ST STE 211
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City | HOUSTON
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State | TX
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Zip | 77002-8941
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Country | US
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Telephone | 817-805-0885
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Fax |
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Provider Business Mailing Address
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Address Line | 206A S LOOP 336 W # 315
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City | CONROE
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State | TX
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Zip | 77304-3300
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Country | US
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Telephone | 817-805-0885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 218213
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License Number State | TX
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