Provider Demographics
NPI:1811472491
Name:VANDER WERP, COURTNEY LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:VANDER WERP
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 1:30903 W 10 MILE RD
Mailing Address - Street 2:STE B
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2615
Mailing Address - Country:US
Mailing Address - Phone:248-893-6192
Mailing Address - Fax:248-457-5490
Practice Address - Street 1:28000 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0961
Practice Address - Country:US
Practice Address - Phone:248-395-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008703225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics