Provider Demographics
NPI:1003424524
Name:GAMMELL, EMILY (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GAMMELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:KOCIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:228 KING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2364
Mailing Address - Country:US
Mailing Address - Phone:774-225-0938
Mailing Address - Fax:
Practice Address - Street 1:228 KING ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2364
Practice Address - Country:US
Practice Address - Phone:413-727-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12432225X00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12432OtherSTATE LICENSURE