Provider Demographics
NPI:1104951078
Name:STITES, CORINNE (OTRL)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:STITES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 ELAINE TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4017
Mailing Address - Country:US
Mailing Address - Phone:423-894-4774
Mailing Address - Fax:423-894-4775
Practice Address - Street 1:4295 CROMWELL RD
Practice Address - Street 2:STE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2166
Practice Address - Country:US
Practice Address - Phone:423-894-4774
Practice Address - Fax:423-894-4775
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT1928225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics