Provider Demographics
NPI:1114333283
Name:JORDAN, COURTNEY PAIGE (COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PAIGE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:PAIGE
Other - Last Name:BURROUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203
Mailing Address - Country:US
Mailing Address - Phone:316-618-1252
Mailing Address - Fax:
Practice Address - Street 1:423 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203
Practice Address - Country:US
Practice Address - Phone:316-618-1252
Practice Address - Fax:316-869-2277
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00791224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant