Healthcare Provider Details

I. General information

NPI: 1588718472
Provider Name (Legal Business Name): COURTNEY ONNOLEE DICKINSON OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S 17TH ST STE 100
WILMINGTON NC
28401-6663
US

IV. Provider business mailing address

1911 S 17TH ST STE 100
WILMINGTON NC
28401-6663
US

V. Phone/Fax

Practice location:
  • Phone: 910-313-2111
  • Fax: 919-928-9423
Mailing address:
  • Phone: 910-313-2111
  • Fax: 919-928-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5543
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5543
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: