Healthcare Provider Details

I. General information

NPI: 1295220515
Provider Name (Legal Business Name): EMILY KHOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N 19TH AVE
PHOENIX AZ
85021-7967
US

IV. Provider business mailing address

7540 N 19TH AVE
PHOENIX AZ
85021-7967
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number60707598
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: