Provider Demographics
NPI:1235493552
Name:MERRITT, COURTNEY LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEE
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5858 MAIN ST STE 160
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4108
Mailing Address - Country:US
Mailing Address - Phone:972-712-2669
Mailing Address - Fax:972-712-4514
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:972-884-4390
Practice Address - Fax:972-674-2616
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114115OtherLICENSE FOR OCCUPATIONAL THERAPY