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General NPI Number Information
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NPI Number | 1548851348
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Entity Type | Individual
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Provider Name | COURTNEY JOSEPH
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 130 N GROSS RD STE 125
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City | KINGSLAND
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State | GA
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Zip | 31548-6263
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Country | US
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Telephone | 912-342-8875
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Fax | 912-342-8016
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Provider Business Mailing Address
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Address Line | 4212 CORAL PARK DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-3016
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Country | US
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Telephone | 912-342-8875
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Fax | 912-342-8016
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA15209
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA001480
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT008041
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License Number State | GA
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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 | OT008041
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License Number State | GA
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