Provider Demographics
NPI:1689066383
Name:ANDERSEN, COURTNEY ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ANN
Other - Last Name:BARNWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 CALVARY LANE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-3280
Mailing Address - Country:US
Mailing Address - Phone:423-218-9729
Mailing Address - Fax:423-727-0730
Practice Address - Street 1:146 CALVARY LANE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683
Practice Address - Country:US
Practice Address - Phone:423-218-9729
Practice Address - Fax:423-727-0730
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist