Provider Demographics
NPI:1538321682
Name:AVILLAN, EMILY JOAN (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOAN
Last Name:AVILLAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEADOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2496
Mailing Address - Country:US
Mailing Address - Phone:781-961-5600
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOWBROOK WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2496
Practice Address - Country:US
Practice Address - Phone:781-961-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3543174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist