Provider Demographics
NPI:1518332873
Name:STEPHENSON, COURTNEY M (COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3265
Mailing Address - Country:US
Mailing Address - Phone:912-856-2719
Mailing Address - Fax:
Practice Address - Street 1:1 PEACHTREE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1200
Practice Address - Country:US
Practice Address - Phone:912-927-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001557224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant