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General NPI Number Information
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NPI Number | 1154049831
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Entity Type | Individual
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Provider Name | CORA PETRINO
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 5871 HARBOUR VIEW BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-3669
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Country | US
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Telephone | 757-512-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 107 OLD CART RD
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City | HADDAM
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State | CT
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Zip | 06438-1271
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Country | US
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Telephone | 860-331-3129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5656
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119-009650
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License Number State | VA
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