Provider Demographics
NPI:1508398892
Name:COURTNEY, HOLLY NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOLE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18217 E 51ST STREET CT S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6985
Mailing Address - Country:US
Mailing Address - Phone:816-694-1407
Mailing Address - Fax:
Practice Address - Street 1:1300 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024
Practice Address - Country:US
Practice Address - Phone:816-630-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013036483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist