Provider Demographics
NPI:1285923987
Name:MORTENSEN, COURTNEY ANNA TAGE (OTR/L, CHT)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ANNA TAGE
Last Name:MORTENSEN
Suffix:
Gender:
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 BEACON POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3901
Mailing Address - Country:US
Mailing Address - Phone:770-853-6373
Mailing Address - Fax:
Practice Address - Street 1:1807 SHORT BRANCH DR STE 103
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4424
Practice Address - Country:US
Practice Address - Phone:727-372-0182
Practice Address - Fax:727-372-0517
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist