Provider Demographics
NPI:1578119558
Name:LITECKY, COURTNEY THERESA (OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:THERESA
Last Name:LITECKY
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 1:2710 STATE ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:WEST FRIENDSHIP
Mailing Address - State:MD
Mailing Address - Zip Code:21794-9308
Mailing Address - Country:US
Mailing Address - Phone:443-472-6948
Mailing Address - Fax:
Practice Address - Street 1:2131 DAVIDSONVILLE RD
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1632
Practice Address - Country:US
Practice Address - Phone:443-472-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist