Provider Demographics
NPI:1831606243
Name:CORNING, MARIAH GABRIELLE (MSOTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:GABRIELLE
Last Name:CORNING
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:GABRIELLE
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7740 ROCK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:14847
Mailing Address - Country:US
Mailing Address - Phone:607-279-7319
Mailing Address - Fax:
Practice Address - Street 1:302 W BUFFALO ST.
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-247-2209
Practice Address - Fax:607-758-5271
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist