Basic Information
| Provider Information | |||||||||
| NPI: | 1619259686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | WELSH | ||||||||
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| Credential: | MOT, OTR/L | ||||||||
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| OtherLastName: | WELSH | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | CHRISTINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1649 COUNTRY HILL LN | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630217149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149415945 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3851 ROGER BROOKE DRIVE | ||||||||
| Address2: | BROOKE ARMY MEDICAL CENTER MCHE-QD/CREDENTIALS | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162460 | ||||||||
| FaxNumber: | 2109165102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 04/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 2006030569 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.