Provider Demographics
NPI:1952419160
Name:JAMES, CORYNN (OT)
Entity Type:Individual
Prefix:MRS
First Name:CORYNN
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CLEARFIELD AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3300
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:1975 GLENN MITCHELL DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-321-3300
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16932225X00000X
VA0119001112225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006192V01Medicare ID - Type UnspecifiedMEDICARE PROVIDER #