Healthcare Provider Details

I. General information

NPI: 1679757983
Provider Name (Legal Business Name): VANESSA CORBITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 E MOWRY ST
CHESTER PA
19013-4619
US

IV. Provider business mailing address

53 E MOWRY ST
CHESTER PA
19013-4619
US

V. Phone/Fax

Practice location:
  • Phone: 484-483-7816
  • Fax:
Mailing address:
  • Phone: 484-483-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC009266
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberOC009266
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: