Provider Demographics
NPI:1568578904
Name:JUMAO-AS, CORINNA CARLA (OTR)
Entity Type:Individual
Prefix:MISS
First Name:CORINNA
Middle Name:CARLA
Last Name:JUMAO-AS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9137
Mailing Address - Country:US
Mailing Address - Phone:972-392-7008
Mailing Address - Fax:972-392-1171
Practice Address - Street 1:6029 BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9137
Practice Address - Country:US
Practice Address - Phone:972-392-7008
Practice Address - Fax:972-392-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4335OtherBLUE CROSS BLUE SHIELD