Provider Demographics
NPI:1023786266
Name:WOOLF, EMILY MICHELLE (OTD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MICHELLE
Last Name:WOOLF
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 KENSINGTON LAKES DR UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1363
Mailing Address - Country:US
Mailing Address - Phone:904-770-9852
Mailing Address - Fax:
Practice Address - Street 1:463155 STATE ROAD 200 STE 12
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5506
Practice Address - Country:US
Practice Address - Phone:904-849-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist