Provider Demographics
NPI:1245731900
Name:EMERSON, EMILY KENNY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KENNY
Last Name:EMERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 HAIRE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8807
Mailing Address - Country:US
Mailing Address - Phone:803-548-9113
Mailing Address - Fax:803-548-9116
Practice Address - Street 1:1988 HAIRE RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8807
Practice Address - Country:US
Practice Address - Phone:803-548-9113
Practice Address - Fax:803-548-9116
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty