Provider Demographics
NPI:1912504440
Name:CORNETT, DAISY
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:CORNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2901
Mailing Address - Country:US
Mailing Address - Phone:513-292-1249
Mailing Address - Fax:
Practice Address - Street 1:4921 FAIRFIELD CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2901
Practice Address - Country:US
Practice Address - Phone:513-292-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services