Provider Demographics
NPI:1770965402
Name:EHRGOTT, EMILY (MT-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:EHRGOTT
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:796 LAUREL GROVE RD
Mailing Address - Street 2:APT 1
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4938
Mailing Address - Country:US
Mailing Address - Phone:860-949-2294
Mailing Address - Fax:
Practice Address - Street 1:1678 MERIDEN WATERBURY TURNPIKE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-518-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11552225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist