Provider Demographics
NPI:1063302529
Name:DISOTELL, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DISOTELL
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:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:KROTZ SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70750-0618
Mailing Address - Country:US
Mailing Address - Phone:337-592-2654
Mailing Address - Fax:
Practice Address - Street 1:7597 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:KROTZ SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70750-5205
Practice Address - Country:US
Practice Address - Phone:337-592-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program