Emma Faith Willis, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

478687 Issued in OR

Practice address

400 Crater Lake Ave
Medford, OR 97504-6808

Phone

(541) 613-6505

Fax

(541) 770-9212

NPI assigned

Apr 14, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Emma Faith Tilton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1497441117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N ELM ST",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970133519",
            "telephone_number": "503-263-8903",
            "fax_number": "503-266-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 CRATER LAKE AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975046808",
            "telephone_number": "541-613-6505",
            "fax_number": "541-770-9212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1710 NE Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Grants Pass",
            "state": "OR",
            "postal_code": "975263877",
            "country_code": "US",
            "telephone_number": "541-479-2606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "EMMA",
        "middle_name": "FAITH",
        "name_prefix": "Miss",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-14",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "VA",
            "license": "E3175145",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "OR",
            "license": "478687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMMA",
            "last_name": "TILTON",
            "middle_name": "FAITH",
            "credential": "COTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mark Williams, PA
• Mark K Williams, RPH
• Michelle Williams
• Jeffrey Adam Williamson, LPC
• Judi Willingham
• Hazel Louise Williston
• Scott Williston, MS, QMHP
• Heidi J Wills, OTR/L CHT
• Megan Marlene Wills, MSW, LCSW
• Alexander J Wilson, MD

• Occupational Therapy Assistant in Medford, OR
• Providers in Medford, OR by specialty
• Occupational Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.