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General NPI Number Information
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NPI Number | 1164261988
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Entity Type | Individual
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Provider Name | COURTNEY MARIE WARDLOW MSOT, OTRL
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Gender | Female
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 42804 GARFIELD RD
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City | CLINTON TWP
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State | MI
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Zip | 48038-1656
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Country | US
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Telephone | 586-307-6134
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 N 102ND ST STE 300
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City | OMAHA
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State | NE
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Zip | 68114-2122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 341550
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2474
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31008371A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201013805
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License Number State | MI
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