Provider Demographics
NPI:1891195384
Name:COLE, COURTNEY MARANDA (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:MARANDA
Last Name:COLE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:117 BARRACUDA CT
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-8070
Mailing Address - Country:US
Mailing Address - Phone:336-944-2851
Mailing Address - Fax:
Practice Address - Street 1:624 US HIGHWAY 17 S
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8660
Practice Address - Country:US
Practice Address - Phone:910-329-4444
Practice Address - Fax:910-329-4445
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9245224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant