Provider Demographics
NPI:1740004191
Name:BRATHWAITE, EMILY CHRISTINA
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:CHRISTINA
Last Name:BRATHWAITE
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 1:2308 SAN RAE DR APT L
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2769
Mailing Address - Country:US
Mailing Address - Phone:321-339-9189
Mailing Address - Fax:
Practice Address - Street 1:2310 CROSS POINTE DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3599
Practice Address - Country:US
Practice Address - Phone:937-617-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20242672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist