MEDICARE: CHRISTINA MARIE CORNICK OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT.0007897	CO
2	225X00000X	Occupational Therapist	0119006988	VA

General Provider Information

NPI Number	:	1932677432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE CORNICK OTR/L

Provider Business Mailing Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	757-268-4054
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	757-268-4054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	02/17/2026

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