Provider Demographics
NPI:1235366659
Name:CORNELY, TARRAH MARIE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TARRAH
Middle Name:MARIE
Last Name:CORNELY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-1119
Mailing Address - Country:US
Mailing Address - Phone:931-802-1773
Mailing Address - Fax:
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3418
Practice Address - Country:US
Practice Address - Phone:609-521-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4045225X00000X
NJTR00556100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist