Provider Demographics
NPI:1184740870
Name:CODOGNI, EMILIE (OTRL)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:CODOGNI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N BEACON ST
Mailing Address - Street 2:APT 608
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1936
Mailing Address - Country:US
Mailing Address - Phone:413-822-4876
Mailing Address - Fax:
Practice Address - Street 1:30 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4938
Practice Address - Country:US
Practice Address - Phone:617-734-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist