Basic Information
| Provider Information | |||||||||
| NPI: | 1033500681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORNELL | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9514 4TH ST NE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAKE STEVENS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982581937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253972327 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9514 4TH ST NE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAKE STEVENS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982581937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253972327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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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 | 224Z00000X | OC 60402566 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.