Provider Demographics
NPI:1023752466
Name:HOLT, EMILY RENAE (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENAE
Last Name:HOLT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RENAE
Other - Last Name:WINGFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4164 PLEASANT MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3537
Mailing Address - Country:US
Mailing Address - Phone:571-389-4933
Mailing Address - Fax:
Practice Address - Street 1:21750 RED RUM DR STE 117
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5867
Practice Address - Country:US
Practice Address - Phone:703-505-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002584224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant