Provider Demographics
NPI:1386789857
Name:ROUSH-CORNELL, JOANNAH HOPE (COTAL)
Entity type:Individual
Prefix:MRS
First Name:JOANNAH
Middle Name:HOPE
Last Name:ROUSH-CORNELL
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9219
Mailing Address - Country:US
Mailing Address - Phone:802-558-5096
Mailing Address - Fax:
Practice Address - Street 1:88 PARK ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4710
Practice Address - Country:US
Practice Address - Phone:802-775-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073-0000159224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant