Provider Demographics
NPI:1528747029
Name:ANDERSON, EMILY JUDITH (OTD, OTR)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JUDITH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:JUDITH
Other - Last Name:HEUMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:511 S NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:SD
Mailing Address - Zip Code:57058-8917
Mailing Address - Country:US
Mailing Address - Phone:605-425-3303
Mailing Address - Fax:605-425-3306
Practice Address - Street 1:511 S NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-8917
Practice Address - Country:US
Practice Address - Phone:605-425-3303
Practice Address - Fax:605-425-3306
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist