Provider Demographics
NPI:1851819882
Name:JOLLOTA, EMILY (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JOLLOTA
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SHIFLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 E GORHAM ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1589
Mailing Address - Country:US
Mailing Address - Phone:912-988-1526
Mailing Address - Fax:
Practice Address - Street 1:411 PRAIRIE HEIGHTS DR STE 101
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-2238
Practice Address - Country:US
Practice Address - Phone:608-556-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006818225X00000X
WI6776-26225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist