Provider Demographics
NPI:1932682697
Name:MCINTYRE, COURTNEY GAIL (OTD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:GAIL
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 NE 66TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3078
Mailing Address - Country:US
Mailing Address - Phone:360-885-4684
Mailing Address - Fax:
Practice Address - Street 1:4201 NE 66TH AVE #106
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-9866
Practice Address - Country:US
Practice Address - Phone:360-885-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60868661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist