Provider Demographics
NPI:1568603496
Name:DICKERSON, EMILY LOUISE (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 CLIME RD N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3403
Mailing Address - Country:US
Mailing Address - Phone:614-824-4079
Mailing Address - Fax:
Practice Address - Street 1:4301 CLIME RD N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3403
Practice Address - Country:US
Practice Address - Phone:614-824-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist