MEDICARE: MR. COREY EMERT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT-4694	FL
2	222Q00000X	Developmental Therapist	OT-4694	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649384587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COREY EMERT OTR/L

Provider Business Mailing Address
First Line	:	10870 NW 73RD CT
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-1838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4004
Country	:	US
Telephone Number	:	954-255-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/04/2013

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