Provider Demographics
NPI:1194471458
Name:ZAVALA, EMILY CHARISSA (OT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHARISSA
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:CHARISSA
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3924 4TH AVE S APT B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1615
Mailing Address - Country:US
Mailing Address - Phone:301-471-3588
Mailing Address - Fax:
Practice Address - Street 1:20288 MN-15
Practice Address - Street 2:UNIT 100
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55409-1615
Practice Address - Country:US
Practice Address - Phone:301-471-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTL5905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist