Provider Demographics
NPI:1144330390
Name:BRATTAN, CORNELIA I (OTR/L)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:I
Last Name:BRATTAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 FILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1706
Mailing Address - Country:US
Mailing Address - Phone:530-894-7135
Mailing Address - Fax:530-894-7164
Practice Address - Street 1:1674 FILBERT AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1706
Practice Address - Country:US
Practice Address - Phone:530-894-7135
Practice Address - Fax:530-894-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03889ZMedicare PIN