Provider Demographics
NPI:1366841157
Name:WOOD, EMILY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5664 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CONESUS
Mailing Address - State:NY
Mailing Address - Zip Code:14435-9592
Mailing Address - Country:US
Mailing Address - Phone:585-245-4265
Mailing Address - Fax:
Practice Address - Street 1:502 GREEN MOR CT
Practice Address - Street 2:APT 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6206
Practice Address - Country:US
Practice Address - Phone:585-245-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00005262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer