Healthcare Provider Details

I. General information

NPI: 1912689993
Provider Name (Legal Business Name): EMILY MIOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 DEL REY AVE
CANON CITY CO
81212-2623
US

IV. Provider business mailing address

515 FAIRVIEW AVE
CANON CITY CO
81212-2863
US

V. Phone/Fax

Practice location:
  • Phone: 719-431-2235
  • Fax:
Mailing address:
  • Phone: 719-275-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA0000117
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: