Provider Demographics
NPI:1265673065
Name:REYNOLDS, COURTNEY LOUISE (COTA/L, CEMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LOUISE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:COTA/L, CEMT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LOUISE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 S LENNOX AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5127
Mailing Address - Country:US
Mailing Address - Phone:307-267-8587
Mailing Address - Fax:
Practice Address - Street 1:2221 S LENNOX AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5127
Practice Address - Country:US
Practice Address - Phone:307-267-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator