Provider Demographics
NPI:1124606090
Name:FRALIN, COURTNEY RENEE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENEE
Last Name:FRALIN
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 1:14 BELMAR LN
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3533
Mailing Address - Country:US
Mailing Address - Phone:154-079-7091
Mailing Address - Fax:
Practice Address - Street 1:1229 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3131
Practice Address - Country:US
Practice Address - Phone:540-586-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-009014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist