Provider Demographics
NPI:1275140592
Name:ERNST, EMILY JORDAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JORDAN
Last Name:ERNST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:TUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4908 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4908 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5712
Practice Address - Country:US
Practice Address - Phone:918-984-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5523225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5523OtherOKLAHOMA STATE MEDICAL BOARD