Provider Demographics
NPI:1578160123
Name:CORNELL, EMMA FAITH (ATS)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:FAITH
Last Name:CORNELL
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 BLUE HOUSE RD
Mailing Address - Street 2:APT 9302
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4093
Mailing Address - Country:US
Mailing Address - Phone:614-586-2187
Mailing Address - Fax:
Practice Address - Street 1:9345 BLUE HOUSE RD
Practice Address - Street 2:APT 9302
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4093
Practice Address - Country:US
Practice Address - Phone:614-586-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer