Provider Demographics
NPI:1144872045
Name:HASKINS, COURTNEY MUSTAIN (OTD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MUSTAIN
Last Name:HASKINS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:DRY FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24549-2701
Mailing Address - Country:US
Mailing Address - Phone:434-549-3371
Mailing Address - Fax:
Practice Address - Street 1:100 RORER ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-5455
Practice Address - Country:US
Practice Address - Phone:434-432-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-008219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist