Provider Demographics
NPI:1881458487
Name:BEATON, COURTNEY LYN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYN
Last Name:BEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905B JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4618
Mailing Address - Country:US
Mailing Address - Phone:315-263-5736
Mailing Address - Fax:
Practice Address - Street 1:905B JASMINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4618
Practice Address - Country:US
Practice Address - Phone:315-263-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty