Provider Demographics
NPI:1023790375
Name:COURTAIN, JORDAN EMILE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:EMILE
Last Name:COURTAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BISHOP LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-5776
Mailing Address - Country:US
Mailing Address - Phone:530-570-2888
Mailing Address - Fax:
Practice Address - Street 1:600 BARRETT LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6000
Practice Address - Country:US
Practice Address - Phone:828-771-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11893224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant