Provider Demographics
NPI:1811355647
Name:STYLES, EMALIE LOGAN (MOTR/L)
Entity type:Individual
Prefix:MISS
First Name:EMALIE
Middle Name:LOGAN
Last Name:STYLES
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 HARBOURVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3628
Mailing Address - Country:US
Mailing Address - Phone:954-260-3092
Mailing Address - Fax:
Practice Address - Street 1:1955 N FEDERAL HWY
Practice Address - Street 2:SUITE 253
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1028
Practice Address - Country:US
Practice Address - Phone:954-580-2520
Practice Address - Fax:954-580-2521
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17461225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist