Provider Demographics
NPI:1912324088
Name:ALONZO, COURTNEY (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:ALONZO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 W MISSION DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2292
Mailing Address - Country:US
Mailing Address - Phone:480-232-9251
Mailing Address - Fax:
Practice Address - Street 1:1514 W MISSION DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2292
Practice Address - Country:US
Practice Address - Phone:480-232-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5703225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist