Basic Information
| Provider Information | |||||||||
| NPI: | 1548641285 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINFREY | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | GROVE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743443505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187864434 | ||||||||
| FaxNumber: | 9187864435 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 2ND AVE SW FL 3 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185407736 | ||||||||
| FaxNumber: | 9185407739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1373 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.