Basic Information
| Provider Information | |||||||||
| NPI: | 1649479841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWELL | ||||||||
| FirstName: | JUSTINA | ||||||||
| MiddleName: | DEJANG | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLTEN | ||||||||
| OtherFirstName: | JUSTINA | ||||||||
| OtherMiddleName: | DEJANG | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1085 VAN VOORHIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265053497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045999250 | ||||||||
| FaxNumber: | 3045999254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1085 VAN VOORHIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265053497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045999250 | ||||||||
| FaxNumber: | 3045999254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTR/L1325 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.