Courtney Lee Modesitt, MS,OT

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT004984 Issued in GA

Practice address

634 Tommy Aaron Dr
Gainesville, GA 30506-1504

Phone

(770) 503-7337

Fax

(770) 503-7337

NPI assigned

Mar 26, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brannon Pediatric Services, Inc.

  • Pediatric Physical Therapist
  • Gainesville, GA
  • NPI 1356694806
  NPD (past)

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269561600000",
    "number": "1871817361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 TOMMY AARON DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305061504",
            "telephone_number": "770-503-7337",
            "fax_number": "770-503-7337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 TOMMY AARON DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305061504",
            "telephone_number": "770-503-7337",
            "fax_number": "770-503-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODESITT",
        "first_name": "COURTNEY",
        "middle_name": "LEE",
        "credential": "MS,OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-26",
        "last_updated": "2010-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT004984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Clackum Nutrition LLC
• Mary McCartney Mitchell, RNFA, NP
• Anusha Mittal
• John Delano Mixon Sr., DDS
• Da Eun Mo, PHARM D
• Lori Angeleene Modly, CPNP
• McKenna Elyse Moe, PAC
• Kellie Margaret Moffatt
• Sahir Mohammad, MD
• Sabira Mohammadi, PA

• Pediatric Occupational Therapist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; 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.