Provider Demographics
NPI:1679262273
Name:GALBRAITH, EMILIA ROSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:ROSE
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MO
Mailing Address - Zip Code:64644-8295
Mailing Address - Country:US
Mailing Address - Phone:208-371-0168
Mailing Address - Fax:
Practice Address - Street 1:2601 FAIR ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3525
Practice Address - Country:US
Practice Address - Phone:660-646-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007797224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant