Provider Demographics
NPI:1275828097
Name:MITCHELL, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MITCHELL
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 1:4574 137TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5211
Mailing Address - Country:US
Mailing Address - Phone:813-371-5180
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL PKWY
Practice Address - Street 2:STE 400
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5035
Practice Address - Country:US
Practice Address - Phone:800-806-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103878225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist