Provider Demographics
NPI:1891487013
Name:KORNEGAY, EMILY ATHENA (COTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ATHENA
Last Name:KORNEGAY
Suffix:
Gender:F
Credentials:COTA
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Other - Credentials:
Mailing Address - Street 1:6211 SCHOOLER HILL DR APT 75
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6909
Mailing Address - Country:US
Mailing Address - Phone:540-599-0803
Mailing Address - Fax:
Practice Address - Street 1:613 HAMMONDS LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-3351
Practice Address - Country:US
Practice Address - Phone:410-636-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant