Provider Demographics
NPI:1740760537
Name:WEBER, COURTNEY PAIGE (COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:PAIGE
Last Name:WEBER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3396 KNOX LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-9379
Mailing Address - Country:US
Mailing Address - Phone:920-850-2269
Mailing Address - Fax:
Practice Address - Street 1:3300 W BREWSTER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-6444
Practice Address - Country:US
Practice Address - Phone:920-832-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI405888224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant