Provider Demographics
NPI:1306497359
Name:OUELLETTE, COURTNEY SARAH
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SARAH
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SAYWARD ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3133
Mailing Address - Country:US
Mailing Address - Phone:978-778-5952
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 158D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6279
Practice Address - Country:US
Practice Address - Phone:978-778-5952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency