Provider Demographics
NPI:1033525118
Name:IMLAY, EMILY ANTOINETTE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANTOINETTE
Last Name:IMLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3844
Mailing Address - Country:US
Mailing Address - Phone:330-604-5551
Mailing Address - Fax:
Practice Address - Street 1:2567 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-3844
Practice Address - Country:US
Practice Address - Phone:330-604-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTC547693374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide