Provider Demographics
NPI:1972235448
Name:PAINTER, EMILY IVY (CPO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:IVY
Last Name:PAINTER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:IVY
Other - Last Name:GONZALEZ-ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3342 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5712
Mailing Address - Country:US
Mailing Address - Phone:904-881-4721
Mailing Address - Fax:
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-881-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO03466OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS AND PROSTHETICS