Provider Demographics
NPI:1750595153
Name:RHODES, COURTNEY JOHNSON (MHS, OTR/L, C/NDT)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JOHNSON
Last Name:RHODES
Suffix:
Gender:F
Credentials:MHS, OTR/L, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 WINSLOW CT
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5672
Mailing Address - Country:US
Mailing Address - Phone:864-804-7959
Mailing Address - Fax:864-578-6220
Practice Address - Street 1:905 WINSLOW CT
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5672
Practice Address - Country:US
Practice Address - Phone:864-804-7959
Practice Address - Fax:864-578-6220
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2210225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1462Medicaid