Provider Demographics
NPI:1235431529
Name:EMDE, JOHN PAUL (OT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:EMDE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 E VANDALIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5560
Mailing Address - Country:US
Mailing Address - Phone:707-965-2182
Mailing Address - Fax:
Practice Address - Street 1:25 E THURMAN AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3709
Practice Address - Country:US
Practice Address - Phone:559-791-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist