Provider Demographics
NPI:1497585269
Name:IVY, COURTNEY L (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:IVY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 WATERSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1257
Mailing Address - Country:US
Mailing Address - Phone:205-215-6687
Mailing Address - Fax:
Practice Address - Street 1:19284 COTTONWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3881
Practice Address - Country:US
Practice Address - Phone:207-788-7365
Practice Address - Fax:720-294-0284
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009261225X00000X
COOT.0008652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist