Healthcare Provider Details

I. General information

NPI: 1568279073
Provider Name (Legal Business Name): EMILY HUDSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 7TH AVE
HUNTINGTON WV
25701-2117
US

IV. Provider business mailing address

803 7TH AVE
HUNTINGTON WV
25701-2117
US

V. Phone/Fax

Practice location:
  • Phone: 304-523-1164
  • Fax:
Mailing address:
  • Phone: 304-523-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: