Basic Information
Provider Information
NPI: 1447538343
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNELL
FirstName: COURTNEY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3938 S TAMIAMI TRL
Address2:  
City: SARASOTA
State: FL
PostalCode: 342313622
CountryCode: US
TelephoneNumber: 9413660011
FaxNumber: 9419570033
Practice Location
Address1: 3938 S TAMIAMI TRL
Address2:  
City: SARASOTA
State: FL
PostalCode: 342313622
CountryCode: US
TelephoneNumber: 9413660011
FaxNumber: 9419570033
Other Information
ProviderEnumerationDate: 07/26/2011
LastUpdateDate: 07/26/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XL0004XOT12678FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision

No ID Information.


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