Provider Demographics
NPI:1326510728
Name:OLIVER, COURTNEY JEANETTE (COTA/L, RBT/CBT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEANETTE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:COTA/L, RBT/CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 LAKE STEILACOOM DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5720
Mailing Address - Country:US
Mailing Address - Phone:136-035-9011
Mailing Address - Fax:
Practice Address - Street 1:10140 US-12
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579
Practice Address - Country:US
Practice Address - Phone:360-273-5536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA106S00000X
WAOC60811004224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician