Provider Demographics
NPI:1275664120
Name:MITCHELL, EMMA LOUISE (ATC)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:LOUISE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154-0196
Mailing Address - Country:US
Mailing Address - Phone:802-376-6136
Mailing Address - Fax:
Practice Address - Street 1:9 SHEPPARD LANE
Practice Address - Street 2:
Practice Address - City:SAXTONS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05154-0196
Practice Address - Country:US
Practice Address - Phone:802-376-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10400001232255A2300X
NH03032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer