Provider Demographics
NPI:1356008734
Name:CORNELL, GARRETT MICHAEL (COTA)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:MICHAEL
Last Name:CORNELL
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 CUPPS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:OH
Mailing Address - Zip Code:45628-9586
Mailing Address - Country:US
Mailing Address - Phone:740-649-8785
Mailing Address - Fax:
Practice Address - Street 1:627 CUPPS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:OH
Practice Address - Zip Code:45628-9586
Practice Address - Country:US
Practice Address - Phone:740-649-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-20
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
454920224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
454920OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY