Courtney Lynn Ricard

Individual provider Active NPI Occupational Therapy Assistant · Phoenix, NY

NPI 1003195058 · NPPES record last updated Aug 9, 2011

Key facts

NPI
1003195058
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
007915 (NY)
Practice address
9151 Frenchmans Creek Dr
Phoenix, NY 13135-1537
Phone
(315) 695-5111
NPI assigned
Aug 9, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
007915NYMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 007915 NY Yes

Addresses

Primary practice location

9151 Frenchmans Creek Dr
Phoenix, NY 13135-1537

Mailing address

9151 Frenchmans Creek Dr
Phoenix, NY 13135-1537
Phone (315) 695-5111

Other providers in Phoenix, NY

All providers in Phoenix, NY · Occupational Therapy Assistant in New York

Sources for this page

Verify at the official NPI Registry.