MEDICARE: COURTNEY EWING

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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1780016022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY EWING

Provider Business Mailing Address
First Line	:	132 KATHENDA DR
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9016
Country	:	US
Telephone Number	:	870-384-0783
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 KATHENDA DR
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9016
Country	:	US
Telephone Number	:	870-384-0783
Fax Number	:

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

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	08/08/2013

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Directions to “ COURTNEY EWING ” Practice Location

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