Healthcare Provider Details

I. General information

NPI: 1619843620
Provider Name (Legal Business Name): EMERALD ELIZABETH SMITH COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 W CHEYENNE AVE STE 101
NORTH LAS VEGAS NV
89032-8905
US

IV. Provider business mailing address

3965 W CHEYENNE AVE STE 101
NORTH LAS VEGAS NV
89032-8905
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 702-515-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3694
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: