Healthcare Provider Details

I. General information

NPI: 1629357322
Provider Name (Legal Business Name): COURTNEY ANN UPDEGROVE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY CONDON OTR/L

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HALL ST STE H
CONCORD NH
03301-3442
US

IV. Provider business mailing address

124 HALL ST STE H
CONCORD NH
03301-3442
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-9160
  • Fax: 603-224-2776
Mailing address:
  • Phone: 603-228-9160
  • Fax: 603-224-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3865
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: