Provider Demographics
NPI:1528202686
Name:CORSO-LOCKHART, ALLISON MICHELLE (OTD OTR/L)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MICHELLE
Last Name:CORSO-LOCKHART
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2915
Mailing Address - Country:US
Mailing Address - Phone:516-658-5946
Mailing Address - Fax:631-406-7440
Practice Address - Street 1:147 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2915
Practice Address - Country:US
Practice Address - Phone:516-658-5946
Practice Address - Fax:631-406-7440
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011472-1225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist