Provider Demographics
NPI:1407253461
Name:PULIE, COURTNEY ALISON
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ALISON
Last Name:PULIE
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 1:175 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1078
Mailing Address - Country:US
Mailing Address - Phone:203-396-1136
Mailing Address - Fax:203-374-8824
Practice Address - Street 1:175 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1078
Practice Address - Country:US
Practice Address - Phone:203-396-1136
Practice Address - Fax:203-374-8824
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist