Provider Demographics
NPI:1104311752
Name:POOLEY, CORI LYNN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:LYNN
Last Name:POOLEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21155 N 56TH ST APT 2094
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5530
Mailing Address - Country:US
Mailing Address - Phone:520-414-8908
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD STE 168
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4686
Practice Address - Country:US
Practice Address - Phone:480-483-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-007517225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics