Provider Demographics
NPI:1275043143
Name:MASSIE, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MASSIE
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:BUSHWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20618-0204
Mailing Address - Country:US
Mailing Address - Phone:301-751-4007
Mailing Address - Fax:
Practice Address - Street 1:5 N LA PLATA CT STE 102
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5207
Practice Address - Country:US
Practice Address - Phone:301-609-5494
Practice Address - Fax:301-392-6109
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119-007501225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist