Provider Demographics
NPI:1508552688
Name:ANSAY, COURTNEY ANN BACANI (OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY ANN
Middle Name:BACANI
Last Name:ANSAY
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 1:1954 KANE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1605
Mailing Address - Country:US
Mailing Address - Phone:916-715-2777
Mailing Address - Fax:
Practice Address - Street 1:1954 KANE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1605
Practice Address - Country:US
Practice Address - Phone:916-715-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24024225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics