Provider Demographics
NPI:1194386532
Name:VANCIL, COURTNEY NOELLE (OT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NOELLE
Last Name:VANCIL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SW 34TH ST # 300
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3059
Mailing Address - Country:US
Mailing Address - Phone:405-793-7885
Mailing Address - Fax:
Practice Address - Street 1:1401 SW 34TH ST # 300
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3059
Practice Address - Country:US
Practice Address - Phone:405-793-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012353225X00000X
OK5423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist