Provider Demographics
NPI:1477386134
Name:EDWARDS, EMILY BROOK (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:BROOK
Last Name:EDWARDS
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 1:21998 OLD HIGHWAY 160
Mailing Address - Street 2:
Mailing Address - City:REEDS SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:65737-9209
Mailing Address - Country:US
Mailing Address - Phone:417-251-1514
Mailing Address - Fax:
Practice Address - Street 1:402 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8143
Practice Address - Country:US
Practice Address - Phone:417-336-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024031398224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant