Provider Demographics
NPI:1114408614
Name:ROTELLA, EMMA LOUISE
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:ROTELLA
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 1:201 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2707
Mailing Address - Country:US
Mailing Address - Phone:831-291-2917
Mailing Address - Fax:
Practice Address - Street 1:2121 41ST AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2056
Practice Address - Country:US
Practice Address - Phone:831-424-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician