Provider Demographics
NPI:1487292785
Name:BANKS, COURTNEY TAYLOR (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TAYLOR
Last Name:BANKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SOUTHGATE RD APT 25
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2056
Mailing Address - Country:US
Mailing Address - Phone:607-267-8493
Mailing Address - Fax:
Practice Address - Street 1:170 LAKE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1966
Practice Address - Country:US
Practice Address - Phone:845-292-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19486225X00000X
NY022053225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNAOtherNA