Provider Demographics
NPI:1467122507
Name:COONAHAN, CORINNE MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MICHELLE
Last Name:COONAHAN
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 1:2020 LEGAT LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-3331
Mailing Address - Country:US
Mailing Address - Phone:610-906-9618
Mailing Address - Fax:
Practice Address - Street 1:2020 LEGAT LN
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-3331
Practice Address - Country:US
Practice Address - Phone:610-906-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010112224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant