Provider Demographics
NPI:1285836999
Name:CORNELL, ERIN RAWLING (MSOT)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:RAWLING
Last Name:CORNELL
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:LEIGH
Other - Last Name:RAWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:724 FLORSHEIM DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3757
Mailing Address - Country:US
Mailing Address - Phone:847-886-0847
Mailing Address - Fax:
Practice Address - Street 1:724 FLORSHEIM DR
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3757
Practice Address - Country:US
Practice Address - Phone:847-886-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4943225XP0019X
IL056013986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00882931OtherRR MEDICARE
WI41043100Medicaid
TNQ016905Medicaid
TNQ016905Medicaid
WI41043100Medicaid
WI01994-0073Medicare PIN