Provider Demographics
NPI:1720393556
Name:DAMES, KOURTNI (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KOURTNI
Middle Name:
Last Name:DAMES
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 NW SHIRLEY CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3596
Mailing Address - Country:US
Mailing Address - Phone:954-465-4467
Mailing Address - Fax:
Practice Address - Street 1:315 NW SHIRLEY CT
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3596
Practice Address - Country:US
Practice Address - Phone:954-465-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890876100Medicaid