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General NPI Number Information
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NPI Number | 1851819882
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Entity Type | Individual
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Provider Name | EMILY JOLLOTA MSOTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 411 PRAIRIE HEIGHTS DR STE 101
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City | VERONA
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State | WI
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Zip | 53593-2238
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Country | US
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Telephone | 608-556-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 720 E GORHAM ST APT 203
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City | MADISON
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State | WI
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Zip | 53703-1589
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Country | US
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Telephone | 912-988-1526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT006818
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 6776-26
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License Number State | WI
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