Provider Demographics
NPI:1326369216
Name:SPEIGHTS, COURTNEY NICOLE (BA, COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICOLE
Last Name:SPEIGHTS
Suffix:
Gender:F
Credentials:BA, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17706 I-30 STE 3
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2930
Mailing Address - Country:US
Mailing Address - Phone:501-315-4414
Mailing Address - Fax:501-315-3467
Practice Address - Street 1:17706 I-30 STE 3
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2930
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant