Healthcare Provider Details

I. General information

NPI: 1043581515
Provider Name (Legal Business Name): EMILY ANTOINETTE HURST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2012
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E 5TH ST
CONNERSVILLE IN
47331-3301
US

IV. Provider business mailing address

322 BUCKEYE ST
HAMILTON OH
45011-1631
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-0543
  • Fax:
Mailing address:
  • Phone: 513-844-2658
  • Fax: 513-844-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31004727A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: