Courtney Braselton
Individual provider Active NPI Occupational Therapist · Freeport, IL
NPI 1215474358 · NPPES record last updated Jan 27, 2017
Key facts
- NPI
- 1215474358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056011511 (IL)
- Practice address
- 1045 W Stephenson St
Freeport, IL 61032-4864 - Phone
- (815) 599-6085
- Fax
- (815) 599-6384
- NPI assigned
- Jan 27, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056011511 | IL | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056011511 | IL | Yes |
Addresses
Primary practice location
1045 W Stephenson St
Freeport, IL 61032-4864
Mailing address
421 W Exchange St
PO Box 268
Freeport, IL 61032-4008
Phone (815) 599-7950
Other providers in Freeport, IL
- Mishea Tanise Boggess
- Hannah Boldt
- Tamisha Bonvillain
- Kristen Book
- Amanda L Bradbury
- Amy Brattrud
- Steven John Brill
- Jennifer Kay Brinkmeier Petta
- Broadstep Academy-Illinois Inc
- Broadstep Academy-Illinois Inc
All providers in Freeport, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.