Provider Demographics
NPI:1639505936
Name:SOMMESE, CORINNE NICOLE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:NICOLE
Last Name:SOMMESE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BOUGANVILLA DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3676
Mailing Address - Country:US
Mailing Address - Phone:904-382-9790
Mailing Address - Fax:900-437-3046
Practice Address - Street 1:100 BOUGANVILLA DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3676
Practice Address - Country:US
Practice Address - Phone:904-382-9790
Practice Address - Fax:900-437-3046
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist