Provider Demographics
NPI:1225706047
Name:KORRIE, CSILLA EDIT (COTA)
Entity Type:Individual
Prefix:MRS
First Name:CSILLA
Middle Name:EDIT
Last Name:KORRIE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21229 ROSETTA PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4873
Mailing Address - Country:US
Mailing Address - Phone:703-595-7270
Mailing Address - Fax:
Practice Address - Street 1:44124 WOODRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6935
Practice Address - Country:US
Practice Address - Phone:703-729-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002028224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant