Provider Demographics
NPI:1275072282
Name:MEYERS, COURTNEY FAE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:FAE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:FAE
Other - Last Name:PITTSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2146 ENGLESIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6225
Mailing Address - Country:US
Mailing Address - Phone:989-289-0934
Mailing Address - Fax:
Practice Address - Street 1:2146 ENGLESIDE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6225
Practice Address - Country:US
Practice Address - Phone:989-289-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner