Provider Demographics
NPI:1295556249
Name:BUTEAU, COURTENAY (COTA)
Entity type:Individual
Prefix:MRS
First Name:COURTENAY
Middle Name:
Last Name:BUTEAU
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 ELDORADO CIR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4758
Mailing Address - Country:US
Mailing Address - Phone:352-425-3612
Mailing Address - Fax:
Practice Address - Street 1:415 CATLETT RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5901
Practice Address - Country:US
Practice Address - Phone:865-453-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant