Individual provider Active NPI

Courtney Shallya Durham, COTA/L

  • Occupational Therapy Assistant
  • Columbus, GA
National Provider Identifier
1245887280
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
OTA002437 Issued in GA
Practice address
1479 Grove Park Dr
Columbus, GA 31904
Phone
(706) 530-9409
NPI assigned
Aug 23, 2019
Last updated
Aug 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA002437 GA Primary

Addresses

Primary practice location

1479 Grove Park Dr
Columbus, GA 31904

Mailing address

797 Douglas Dr
Ellerslie, GA 31807-5655
Phone (706) 987-7018

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OTA002437GAMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1245887280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "797 DOUGLAS DR",
            "city": "ELLERSLIE",
            "state": "GA",
            "postal_code": "318075655",
            "telephone_number": "706-987-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 GROVE PARK DR",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31904",
            "telephone_number": "706-530-9409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURHAM",
        "first_name": "COURTNEY",
        "middle_name": "SHALLYA",
        "name_prefix": "Ms.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "GA",
            "license": "OTA002437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.