Provider Demographics
NPI:1902204183
Name:PITTMAN, CORINTHUS OMARI (OTD)
Entity type:Individual
Prefix:MR
First Name:CORINTHUS
Middle Name:OMARI
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 RIDGELAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6526
Mailing Address - Country:US
Mailing Address - Phone:601-502-7857
Mailing Address - Fax:
Practice Address - Street 1:2819 RIDGELAKE DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-6526
Practice Address - Country:US
Practice Address - Phone:601-502-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-20
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2917225X00000X
TX117663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist