Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209704 | TX |
NPI | 1013191220 |
---|---|
Provider Name | Sonda Marie Cornish |
First Address | Kyle, TX 78640-5551 |
Second Address | San Antonio, TX 78232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 24/12/2007 |