Healthcare Provider Details

I. General information

NPI: 1104738970
Provider Name (Legal Business Name): EMMELYNE VILLELA VALLE COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 E 5TH ST
TUCSON AZ
85711-1917
US

IV. Provider business mailing address

3920 E 5TH ST
TUCSON AZ
85711-1917
US

V. Phone/Fax

Practice location:
  • Phone: 520-471-0283
  • Fax:
Mailing address:
  • Phone: 520-481-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number050323
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: