Provider Demographics
NPI:1376926998
Name:PURVIS, COURTNEY RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 S HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-8804
Mailing Address - Country:US
Mailing Address - Phone:662-414-0247
Mailing Address - Fax:
Practice Address - Street 1:177 S HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-8804
Practice Address - Country:US
Practice Address - Phone:662-414-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist