Provider Demographics
NPI:1215309745
Name:SHEA, COURTNEY (OTR/L)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:220 BEAR HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1004
Mailing Address - Country:US
Mailing Address - Phone:781-790-8479
Mailing Address - Fax:781-281-9181
Practice Address - Street 1:220 BEAR HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1004
Practice Address - Country:US
Practice Address - Phone:781-790-8479
Practice Address - Fax:781-281-9181
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14809225X00000X
OR270978225X00000X
WA6052064225X00000X
MA10082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist