Kim Ann Cornelisse, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5202004084 Issued in MI

Practice address

3400 Wilson Ave SW
Grandville, MI 49418-1854

Phone

(616) 534-5487

NPI assigned

Jul 25, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1053898775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 WILSON AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 WILSON AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181854",
            "telephone_number": "616-534-5487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNELISSE",
        "first_name": "KIM",
        "middle_name": "ANN",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MI",
            "license": "5202004084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5202004084",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elyse Simone Comeau
• Diana Lynn Connell, RN
• Rachel Connelly
• Laura Ann-Ennis Conran, DPT
• Sean Corbin, LPC
• Valerie J Cornwall, PT
• Sandra L Cottingham, MD
• David O Cramer, DDS,MS,PC
• Josalyn Marie Cramer
• Chastity Dawn Crawford

• Occupational Therapy Assistant in Grandville, MI
• Providers in Grandville, MI by specialty
• Occupational Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.