Provider Demographics
NPI:1972657625
Name:CORSALE, STEPHEN (DIPL OM LAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:CORSALE
Suffix:
Gender:M
Credentials:DIPL OM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 ARAPAHOE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9100
Mailing Address - Country:US
Mailing Address - Phone:720-201-9156
Mailing Address - Fax:
Practice Address - Street 1:4440 ARAPAHOE AVE STE 215
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-9100
Practice Address - Country:US
Practice Address - Phone:720-201-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO841171100000X
978346225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics