Provider Demographics
NPI:1548017866
Name:CORNISH, DEVIN TAYLOR (OTR/L)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:TAYLOR
Last Name:CORNISH
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 1:6929 LAKE DR APT E
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3372
Mailing Address - Country:US
Mailing Address - Phone:925-918-1814
Mailing Address - Fax:
Practice Address - Street 1:4471 STONERIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8403
Practice Address - Country:US
Practice Address - Phone:925-425-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist