Healthcare Provider Details

I. General information

NPI: 1952007387
Provider Name (Legal Business Name): EMMA WILT BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 W DUBLIN GRANVILLE RD
DUBLIN OH
43017-1436
US

IV. Provider business mailing address

20 INDIAN TRL
FORT LORAMIE OH
45845-9357
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-4465
  • Fax:
Mailing address:
  • Phone: 937-489-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-78970
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: