Provider Demographics
NPI:1477904928
Name:COSTA, EMILIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:COSTA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TRADECENTER
Mailing Address - Street 2:SUITE 4890
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 TRADECENTER
Practice Address - Street 2:SUITE 4890
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7452
Practice Address - Country:US
Practice Address - Phone:781-937-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor