Provider Demographics
NPI:1932439296
Name:SCHMIT, COURTNEY KAYE (COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KAYE
Last Name:SCHMIT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 N LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9551
Mailing Address - Country:US
Mailing Address - Phone:309-397-4820
Mailing Address - Fax:
Practice Address - Street 1:12115 N LAKE FOREST DR
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-9551
Practice Address - Country:US
Practice Address - Phone:309-397-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002470224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant