Individual
TIA CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1601 PRECISION PARK LN, SAN YSIDRO, CA 92173-1345
(619) 205-4585
Mailing address
1445 KECK RD, CHULA VISTA, CA 91913-3564
(630) 336-6216
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4979
CA
Other
Enumeration date
08/23/2018
Last updated
02/14/2023
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