Provider Demographics
NPI:1013581032
Name:HATTLE, COURTNEY ELAINE (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELAINE
Last Name:HATTLE
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:720-249-7726
Mailing Address - Fax:
Practice Address - Street 1:110 S ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:720-249-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOT.0006494OtherOCCUPATIONAL THERAPY
COOT.0006494OtherSTATE OF COLORADO DEPARTMENT OF REGULATORY AGENCIES