Provider Demographics
NPI:1760668644
Name:PIEPER, COURTNEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:PIEPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1337
Mailing Address - Country:US
Mailing Address - Phone:580-928-5541
Mailing Address - Fax:580-928-3582
Practice Address - Street 1:501 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-1337
Practice Address - Country:US
Practice Address - Phone:580-928-5541
Practice Address - Fax:580-928-3582
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1608OtherPTA LICENSE