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General NPI Number Information
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NPI Number | 1689866790
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Entity Type | Individual
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Provider Name | MARK ALAN COURTNEY PROVIDER
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 2508 CENTRAL AVE
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City | CODY
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State | WY
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Zip | 82414-9797
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Country | US
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Telephone | 307-527-4616
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2081
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City | CODY
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State | WY
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Zip | 82414-2081
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Country | US
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Telephone | 307-527-4616
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | WY
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