Individual
CORRINE SISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31007428A
IN
225XH1200X
Hand Occupational Therapist
31007428A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300069712
—
IN
01
—
31007428A
STATE LICENSE
IN
Enumeration date
06/15/2021
Last updated
05/24/2024
Update your record
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