Provider Demographics
NPI:1093342339
Name:MOOREFIELD, EMILY MARSZALKOWSKI (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MARSZALKOWSKI
Last Name:MOOREFIELD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:KATE
Other - Last Name:MARSZALKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6032 VILLE DE SANTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6032 VILLE DE SANTE DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1137
Practice Address - Country:US
Practice Address - Phone:402-571-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1070224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131-001993OtherSTATE BOARD
IA097937OtherSTATE BOARD
NE1070OtherSTATE BOARD