Provider Demographics
NPI:1922759463
Name:MCCORMICK, ARELIOUS (CPED)
Entity Type:Individual
Prefix:MR
First Name:ARELIOUS
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:ARELIOUS
Other - Middle Name:
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPED, BOCPD, LPED
Mailing Address - Street 1:8298 BRIGANTINE CT
Mailing Address - Street 2:UNIT 75
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-504-3751
Mailing Address - Fax:
Practice Address - Street 1:8298 BRIGANTINE CT
Practice Address - Street 2:APT75
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4506
Practice Address - Country:US
Practice Address - Phone:513-504-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00247224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist