Provider Demographics
NPI:1033500681
Name:CORNELL, BRITTANY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:CORNELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9514 4TH ST NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1937
Mailing Address - Country:US
Mailing Address - Phone:425-397-2327
Mailing Address - Fax:
Practice Address - Street 1:9514 4TH ST NE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60402566224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant