Provider Demographics
NPI:1356182653
Name:ROBERTS, COURTNEY MARIE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WESTMINSTER DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-8405
Mailing Address - Country:US
Mailing Address - Phone:504-427-6270
Mailing Address - Fax:
Practice Address - Street 1:2106 RUE SIMONE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5728
Practice Address - Country:US
Practice Address - Phone:985-662-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA341822225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist