Healthcare Provider Details

I. General information

NPI: 1669393690
Provider Name (Legal Business Name): COURTNEY KOENIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 JAMESTOWN RD
WILLIAMSBURG VA
23185-2326
US

IV. Provider business mailing address

298 BIG DRAFT RD
WHITE SULPHUR SPRINGS WV
24986-2102
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-9991
  • Fax:
Mailing address:
  • Phone: 304-647-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131003199
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: