Provider Demographics
NPI:1588857296
Name:CORNWELL, ALISON GREEN (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:GREEN
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8025
Mailing Address - Country:US
Mailing Address - Phone:340-626-0917
Mailing Address - Fax:340-626-0917
Practice Address - Street 1:COMPLEAT KIDZ
Practice Address - Street 2:518 N. GENERALS BLVD D
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:417-293-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33562225X00000X
MO2003003219225X00000X
NC3352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist