Healthcare Provider Details

I. General information

NPI: 1326646068
Provider Name (Legal Business Name): EMILY ANN WURST COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 ELMWOOD AVE
ERIE PA
16508-1421
US

IV. Provider business mailing address

28100 TORCH PKWY
WARRENVILLE IL
60555-4026
US

V. Phone/Fax

Practice location:
  • Phone: 814-920-1230
  • Fax:
Mailing address:
  • Phone: 630-413-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOP007940
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: