Provider Demographics
NPI:1598138711
Name:POWERS, COURTNEY NICOLE (MOT, OTR/L, CHT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:MOT, OTR/L, CHT
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8004 AUBURN OAKS VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0700
Mailing Address - Country:US
Mailing Address - Phone:507-250-1732
Mailing Address - Fax:
Practice Address - Street 1:2550 DOUGLAS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3996
Practice Address - Country:US
Practice Address - Phone:916-772-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22348225X00000X
201905063225XH1200X
MN105011225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist