Provider Demographics
NPI:1619377215
Name:MCCORKLE, JUDY (COTA/L)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:10157 MAHONING AVE
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-0134
Mailing Address - Country:US
Mailing Address - Phone:330-398-6222
Mailing Address - Fax:
Practice Address - Street 1:10157 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9751
Practice Address - Country:US
Practice Address - Phone:330-398-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005051224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant