Provider Demographics
NPI:1720712037
Name:EMILE, EMILIENNE TIANA (COTA)
Entity type:Individual
Prefix:
First Name:EMILIENNE
Middle Name:TIANA
Last Name:EMILE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 CYPRESS ISLAND DR APT 507
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4493
Mailing Address - Country:US
Mailing Address - Phone:754-245-4224
Mailing Address - Fax:
Practice Address - Street 1:2213 CYPRESS ISLAND DR APT 507
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4493
Practice Address - Country:US
Practice Address - Phone:754-245-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11822224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant