MEDICARE: CORTNEY COUITCHER OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT15009	FL

General Provider Information

NPI Number	:	1376125229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORTNEY COUITCHER OT

Provider Business Mailing Address
First Line	:	1171 JACKSON CT
Second Line	:
City	:	CREEDMOOR
State	:	NC
Zip	:	27522-7281
Country	:	US
Telephone Number	:	989-751-0639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1171 JACKSON CT
Second Line	:
City	:	CREEDMOOR
State	:	NC
Zip	:	27522-7281
Country	:	US
Telephone Number	:	989-751-0639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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