Healthcare Provider Details

I. General information

NPI: 1528637675
Provider Name (Legal Business Name): ELEANOR CORBETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E DIVISION ST
MOUNT VERNON WA
98274-4004
US

IV. Provider business mailing address

1101 E DIVISION ST
MOUNT VERNON WA
98274-4004
US

V. Phone/Fax

Practice location:
  • Phone: 360-899-4905
  • Fax: 360-899-9370
Mailing address:
  • Phone: 360-899-4905
  • Fax: 360-899-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: