Provider Demographics
NPI:1417011255
Name:ROCKWELL, COURTNEY ANN (MS, OTR)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:ROCKWELL
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CUMBERLAND PL
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5083
Mailing Address - Country:US
Mailing Address - Phone:207-262-7173
Mailing Address - Fax:207-262-7226
Practice Address - Street 1:1 CUMBERLAND PL
Practice Address - Street 2:SUITE 122
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-262-7173
Practice Address - Fax:207-262-7226
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9422Medicare ID - Type Unspecified