Provider Demographics
NPI:1851469589
Name:PITTMAN, COURTNEY (OCCUPATION THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:OCCUPATION THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 WINDING LN STE 105
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4067
Mailing Address - Country:US
Mailing Address - Phone:423-645-2746
Mailing Address - Fax:
Practice Address - Street 1:5819 WINDING LN STE 101
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4067
Practice Address - Country:US
Practice Address - Phone:423-645-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003962225X00000X
TN4676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA936250461FMedicaid
TN1516681Medicaid
GA52133837002OtherBCBS
100052554OtherAMERIGROUP
339877OtherWELLCARE