Provider Demographics
NPI:1730976531
Name:JOHNSTON, MITCHELL (OT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 LOS MOLINOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5253
Mailing Address - Country:US
Mailing Address - Phone:916-799-8383
Mailing Address - Fax:866-225-9947
Practice Address - Street 1:10358 PEDRA DO SOL WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3471
Practice Address - Country:US
Practice Address - Phone:916-730-7092
Practice Address - Fax:866-225-9947
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist