Provider Demographics
NPI:1093964488
Name:O'NEILL, CORRINNE MARIE
Entity Type:Individual
Prefix:
First Name:CORRINNE
Middle Name:MARIE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORRINNE
Other - Middle Name:MARIE
Other - Last Name:DEROLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:7526 VALLEY CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6821
Mailing Address - Country:US
Mailing Address - Phone:716-648-9211
Mailing Address - Fax:
Practice Address - Street 1:1100 VOLVO PKWY STE 320
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3341
Practice Address - Country:US
Practice Address - Phone:757-606-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011345-1174400000X
VA0119004945225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist