Provider Demographics
NPI:1104135318
Name:CORSON, EUGENIE RUTH (COTA)
Entity type:Individual
Prefix:
First Name:EUGENIE
Middle Name:RUTH
Last Name:CORSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 RODEO DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:PA
Mailing Address - Zip Code:16644
Mailing Address - Country:US
Mailing Address - Phone:814-687-4930
Mailing Address - Fax:
Practice Address - Street 1:133 RODEO DRIVE
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:PA
Practice Address - Zip Code:16644
Practice Address - Country:US
Practice Address - Phone:814-687-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001335L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant