Provider Demographics
NPI:1861145062
Name:WILFORD, EMMA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:WILFORD
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 E CALLE ALARCON
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5017
Mailing Address - Country:US
Mailing Address - Phone:520-260-1590
Mailing Address - Fax:
Practice Address - Street 1:5151 E BROADWAY BLVD STE 1600
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3777
Practice Address - Country:US
Practice Address - Phone:480-613-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008689225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
463282OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
AZ008689OtherSTATE OF ARIZONA BOARD OF OCCUPATIONAL THERAPY EXAMINERS