Healthcare Provider Details

I. General information

NPI: 1700445707
Provider Name (Legal Business Name): COURTNEY LYNN HEATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

559 FALLS DR
CLAYTON NC
27527-5558
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: