Provider Demographics
NPI:1598253403
Name:MCGUIRE, COURTNEY ALYSE (COTA/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALYSE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 TRIMBLE RD APT A1
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3841
Mailing Address - Country:US
Mailing Address - Phone:843-687-9721
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-296-1000
Practice Address - Fax:610-925-4000
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant