Healthcare Provider Details

I. General information

NPI: 1952947194
Provider Name (Legal Business Name): COURTNEY SEIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 OTTERSREST LN
CAPE CORAL FL
33990-6853
US

IV. Provider business mailing address

1914 OTTERSREST LN
CAPE CORAL FL
33990-6853
US

V. Phone/Fax

Practice location:
  • Phone: 847-894-0651
  • Fax:
Mailing address:
  • Phone: 847-894-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT19702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: