Provider Demographics
NPI:1295964344
Name:CORDER, CORTNEY BROOKE (OTR/L)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:BROOKE
Last Name:CORDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 REGAL DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2248
Mailing Address - Country:US
Mailing Address - Phone:304-614-2476
Mailing Address - Fax:
Practice Address - Street 1:104 REGAL DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2248
Practice Address - Country:US
Practice Address - Phone:304-614-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist