Provider Demographics
NPI:1558181149
Name:JOHNSON, EMMA SOLEIL (C/OTAL)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:SOLEIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:C/OTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-4466
Mailing Address - Country:US
Mailing Address - Phone:606-585-8288
Mailing Address - Fax:
Practice Address - Street 1:724 PATRICIA ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-4466
Practice Address - Country:US
Practice Address - Phone:606-585-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC2383224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty