Provider Demographics
NPI:1770026999
Name:JOHNSON, EMILY L (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 COUGAR AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8444
Mailing Address - Country:US
Mailing Address - Phone:307-527-7060
Mailing Address - Fax:307-587-2497
Practice Address - Street 1:2531 COUGAR AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8444
Practice Address - Country:US
Practice Address - Phone:307-527-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-19
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTA-1337224Z00000X
IL057004629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant