Provider Demographics
NPI:1841700416
Name:ANDRYC, COURTNEY (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ANDRYC
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:ATWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:302 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-1502
Mailing Address - Country:US
Mailing Address - Phone:419-261-0020
Mailing Address - Fax:
Practice Address - Street 1:710 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3224
Practice Address - Country:US
Practice Address - Phone:419-334-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist