Individual
MISS EMMA FAITH WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
400 CRATER LAKE AVE, MEDFORD, OR 97504-6808
(541) 613-6505
(541) 770-9212
Mailing address
113 N ELM ST, CANBY, OR 97013-3519
(503) 263-8903
(503) 266-8632
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E3175145
VA
224Z00000X
Occupational Therapy Assistant
Primary
478687
OR
Other
Enumeration date
04/14/2023
Last updated
07/15/2024
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