Provider Demographics
NPI:1114199577
Name:CARSMAN, COURTNEY LEE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:CARSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5192
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-5192
Mailing Address - Country:US
Mailing Address - Phone:513-309-3905
Mailing Address - Fax:650-560-2530
Practice Address - Street 1:5150 CONVAIR DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0425
Practice Address - Country:US
Practice Address - Phone:513-309-3905
Practice Address - Fax:650-560-2530
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV08-0049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV296505Medicare UPIN