Provider Demographics
NPI:1295495505
Name:JAMES, COURTNEY ALLISON
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ALLISON
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SAMUEL LN
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-3055
Mailing Address - Country:US
Mailing Address - Phone:931-242-8917
Mailing Address - Fax:
Practice Address - Street 1:1311 S LOCUST AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4054
Practice Address - Country:US
Practice Address - Phone:931-766-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000003720Medicaid