MEDICARE: EMILIA LEIGH KOZLOWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1801730700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIA LEIGH KOZLOWSKI

Provider Business Mailing Address
First Line	:	1028 CEDAR FOREST DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5405
Country	:	US
Telephone Number	:	757-807-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 EDEN WAY N
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3339
Country	:	US
Telephone Number	:	757-807-1867
Fax Number	:	757-807-1867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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